C. Contact ListMireya Williams Policy, TANF 503-945-7016 503-945-6094 [email protected] TANF Tribal Policy Tribal TANF Agreement Mireya Williams Lily Sehon 503-945-6094 503-945-5624

FSML – 64D

February 29, 2012 Introduction C – Contact List C - 1

C. Contact List

1. Information resources

Information Resource Phone

Adoption Assistance

A – C

D – K

L – O

P – S

T - Z

Karen Cremer

Courtney Nichols

Sue Bakke

Karen Cremer

Sue Bakke

503-945-6642

503-947-5092

503-947-5312

503-945-6642

503-947-5312

Alcohol & Drug Lisa Buss/Amy Sevdy

Patrick J. Ring

503-945-7017

503-945-7006

Alternate Formats DHS Forms 503-373-7690 Fax

AmeriCorps (Teen

Pregnancy Prevention) Tina McCollum

503-945-6906

Breastfeeding (TANF) Amy Sevdy 503-945-7017

CAF SSP Web

applications (such as Notice

Retention, OHP application

tracker, SNAP and TANF

calculation webpage)

Alma Estrada

Leslie Potter

Lisa Stegmann

Service Desk

503-947-5304

503-945-6293

503-945-6725

503-945-5623

CAWEM Joyce Clarkson

Carol Berg

Vonda Daniels

Michelle Mack

Christy Garland

Jewell Kallstrom

503-945-6106

503-945-6072

503-945-6088

503-947-5129

503-947-5519

503-947-2316

Child Care Annette Aylett

Karen Collette

Jennifer Irving

503-945-6092

503-378-3510

503-378-2731, x. 31186

Child Support See Specific Program Area

CMS & FSMIS issues Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

Client Maintenance Unit

(CMU)

For changes or corrections to

eligibility coding

503-378-4369

Confidentiality (Self-

Sufficiency)

Linda Weight

Caroline Burnell

503-945-6952

503-945-6640

FSML – 64D

C - 2 Introduction C – Contact List February 29, 2012


Domestic Violence/TA-

DVS Eligibility

Carol Krager

Policy, TANF

Lily Sehon

Tammy Brooks

Stephanie Jernstedt

Patrick J. Ring

Mireya Williams

Amy Sevdy/Lisa Buss

503-945-5931

[email protected]

503-945-5624

503-945-7016

503-945-6737

503-945-7006

503-945-6094

503-945-7017

EBT Bill Walker

Lisa Stegmann

503-945-6075

503-945-6725

Eligibility Determination

Period (EDP)

Patrick J. Ring

Stephanie Jernstedt

503-945-7006

503-945-6737

Employed Persons with

Disabilities Program

Jeff Stell 503-945-6834

Estate Administration Unit (EAU)

Inquiries 503-378-2884

Exceptional Needs Care

Coordinator (specialized case

management of complex

medical needs of clients in

managed health care plans)

Each health plan has its own

Exceptional Needs Care Coordinator.

Use the OHP 9031A thru OHP 9031Z

(Compare Your Health Plan Choices

listed by county) to find toll free

phone number for the client‟s health

plan.

Call the health plan‟s toll free number

to find out who the Exceptional

Needs Care Coordinator is.

Family Support and

Connections (FS&C)

Stephanie Jernstedt

Patrick J.Ring

503-945-6737

503-945-7006

Forms and Documents Lynette Sylvester (use Outlook email box:

DHS FORMS)

503-378-3505

Fraud Hotline To report potential fraud 888-372-8301

888-FRAUD01

Health issues (Physical health, intellectual

functioning, mental health, SSI)

Disability Analysts:

Tom Shores (D3)

Janice Norton (D5)

Alice McDonald (D5)

Bonnie Parypa (D1 & 9)

Joy Plummer (D6 & 7)

Scott Hampton (D2 & 15)

Vacant (D12, 13, & 14)

Gary Davidson (D2)

Cathy Rhodes (D2)

Michael Mallorie (D4)

Kathleen Coolidge (D8)

Rebecca Smallwood (D10/ 11)

Julie Woods (D16)

Ed Scott (D16)

503-373-7073 x567

541-726-6644 x2249

541-726-6644 x2311

503-366-8370

541-888-7017

503-731-3299

541-966-0880

971-673-6877

971-673-6886

541-791-5879

541-776-6024 x224

541-815-3223

503-277-6739

503-277-6798

FSML – 64D



Health Insurance Group

(HIG)

For assistance with Third Party

Liability (TPL)

503-378-6233

Housing Stabilization

Program (HSP)

HSP Contract

Carol Krager

Lily Sehon

503-945-5931

503-945-5624

Investigations John Carter 503-378-3765

JASR payment screen Lisa Stegmann Alma Estrada Leslie Potter

503-945-6725

503-947-5304

503-945-6293

Job Participation Incentive

(JPI)

Tammy Brooks

Amy Sevdy 503-945-7016

503-945-7017

Job retention/transition SNAP:

Dawn Myers

Rosanne Richard

Sandy Ambrose

Eliza Devlin

Sarah Lambert

Kathleen Scott

Heidi Wormwood

Child Care:

Annette Aylett

Karen Collette

Jennifer Irving

TANF: Tammy Brooks

Policy, TANF

503-945-7018

503-945-5826

503-945-6092

503-947-5105

503-945-6220

503-945-6111

503-945-5737

503-945-6092

503-378-3510

503-378-2731, x. 31186

503-945-7016

[email protected]

JOBS Plus (operations &

policy) Lily Sehon

Tammy Brooks

Policy,TANF

503-945-5624

503-945-7016

[email protected]

JOBS Microenterprise Lily Sehon 503-945-5624

JOBS Program Patrick J. Ring

Tammy Brooks

Lily Sehon

Mireya Williams

Carol Krager

Stephanie Jernstedt

Amy Sevdy/Lisa Buss

Policy, TANF

503-945-7006

503-945-7016

503-945-5624

503-945-6094

503-945-5931

503-945-6737

503-945-7017

[email protected]

Learning Disabilities Patrick J. Ring 503-945-7006

FSML – 64D



Mainframe Systems (CMS,

FSMIS, JAS, SPL1, BENDEX,

TPQY, EBT, Provider, Special

Cash Pay)

Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

Managed Health Care

Plans issues

See: Prepaid Health Plan

Coordinators See: Exceptional Needs Care

Coordinators

Medical programs of CAF

Self-Sufficiency (OHP,

TANF medical, TANF

extended medical, CAWEM)

Joyce Clarkson

Michelle Mack

Carol Berg

Vonda Daniels

Jewel Kallstrom

Christy Garland

503-945-6106

503-947-5129

503-945-6072

503-945-6088

503-947-2316

503-947-5519

Medical transportation Medical transportation program

manager in DMAP

503-945-6493

Medicare Part D and Low

Income Subsidy (LIS)

Dale Marande 503-947-5281

Mental Health Lisa Buss/Amy Sevdy

Patrick J. Ring

503-945-7017

503-945-7006

MHO exceptions Donna Metzger 503-947-5528

Noncitizen policy See specific program analyst

Noncustodial parents DCS Program Analyst (Child

Support Issues)

503-986-6166

Notices

Content

Technical Issues

See Specific Program Area

Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

NOTM:

Content

Technical Issues

See Specific Program Area

Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

OHP program See Medical programs

OHP (information on

medical services covered)

DMAP 503-945-5772 (Salem)

800-527-5772

Office of Payment

Accuracy and Recovery

(OPAR)

Policy Analysts

Carolyn Thiebes (HIG, MPR)

FIU, OWU, ORU

Sharon Arrington

(CMU, DMU)

Rick Mills (EAU, PIL)

Barbara Zharkoff

(PERM, PAU)

503-378-3507

503-378-3510

503-378-3304

503-378-3289

503-378-3299

FSML – 64D



OFSET:

Supplemental Nutrition

Assistance Program –

Employment and Training

Dawn Myers

Rosanne Richard

Sandy Ambrose

Eliza Devlin

Sarah Lambert

Kathleen Scott

Heidi Wormwood

503-945-7018

503-945-5826

503-945-6092

503-947-5105

503-945-6220 503-945-6111

503-945-5737

OSIPM Michael Avery

Selina Hickman

Jeff Stell

503-945-6410

503-945-6139

503-945-6834

Overpayment:

Collections

Writers

Screens/Systems

questions

Steve Stover

Angela Molthan

Lisa Stegmann

Alma Estrada

Leslie Potter

503-373-7772

503-373-1872

503-945-6725

503-947-5304

503-945-6293

Parents as Scholars (PAS) Lisa Buss/Amy Sevdy 503-945-7017

PC JAS Service Desk 503-945-5623

Personal Injury Lien (PIL) Inquiries 503-378-4514

Post-TANF Tammy Brooks

Policy, TANF

503-945-7016

[email protected]

Prepaid Health Plan

Coordinators (managed

health care plans enrollment

issues)

DMAP: Call the 800 number to

identify the PHP Coordinator for the

health plan you are interested in.

800-527-5772

Presumptive

Disability/OSIP

Brian Kirk 503-373-0271

QMB Dale Marande

Jeff Stell

503-945-6476

503-945-6834

RACF Monica Allen 503-945-6890

Refugee Programs Tony Scott

Neeru Kanal

503-947-5261

971-673-5774

Repatriate Gloria Anderson 503-945-5700

SSI Brian Kirk 503-373-0271

State Family Pre-

SSI/SSDI Program

(SFPSS)

Patrick J. Ring

Erika Miller

503-945-7006

503-945-5915

Subpoenas Caroline Burnell 503-945-6640


Assistance Program

(SNAP)

Dawn Myers

Rosanne Richard

Sandy Ambrose

Eliza Devlin

Sarah Lambert

Kathleen Scott

Heidi Wormwood

503-945-7018

503-945-5826

503-945-6092

503-947-5105

503-945-6220

503-945-6111

503-945-5737

FSML – 64D



TANF Mireya Williams

Tammy Brooks

Patrick J. Ring

Carol Krager

Lily Sehon

Amy Sevdy/Lisa Buss

Stephanie Jernstedt

Policy, TANF

503-945-6094

503-945-7016

503-945-7006

503-945-5931

503-945-5624

503-945-7071

503-945-6737

[email protected]

TANF Child Support Amy Sevdy/Lisa Buss

Carol Krager (Good Cause)

Policy, TANF

503-945-7017

503-945-5931

[email protected]

TANF Civil Rights Issues Patrick J.Ring 503-945-7006

TANF Disability Issues Patrick J.Ring 503-945-7006

TANF Re-engagement or

Disqualification

Patrick J. Ring 503-945-7006

TANF Time Limits Tammy Brooks

Mireya Williams

Policy, TANF

503-945-7016

503-945-6094

[email protected]

TANF Tribal Policy

Tribal TANF Agreement

Mireya Williams

Lily Sehon

503-945-6094

503-945-5624

TRACS Leslie Potter

Alma Estrada

Lisa Stegmann

Service Desk

503-945-6293

503-947-5304

503-945-6725

503-945-5623

Translation DHS Forms 503-373-7690 Fax

Tribal issues

- Indian Child Welfare

Act (ICWA)

- Tribal TANF

Agreement

Mary McNevins

Rick Acevedo

Lily Sehon

503-945-7022

503-945-7034

503-945-5624

Trusts (OSIP) Bill Brautigam 503-947-5204

ViewDirect reports (aka

Mobius)

Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

Vocational Rehabilitation

Services

Ron Barcikowski 503-945-6734

Workforce Investment Act

(WIA)

One-Stop Resource

Sharing Agreements

Lily Sehon 503-945-5624

WSIT/WJSS (JOBS child

care payment screens)

Lisa Stegmann

Alma Estrada

Leslie Potter

503-945-6725

503-947-5304

503-945-6293

FSML – 64D


2. Information resource email groups

(Outlook email addresses for policy questions)

Program Name Email Address

CAF SSP Training Unit (includes SSP/PSU

Collaboration)

CAF, SSPTraining

CAF Technical and Child Welfare Training

Units

CAF, TrainingServices

Child Care Program Childcare Policy

Supplemental Nutrition Assistance Program SNAP Policy

Medical Program Medical SSP-Policy

Office of Payment Accuracy and Recovery

Policy questions related to:

HIG, PIL, Overpayments, Fraud, EAU, CMU

OPAR-Policy Unit

TANF Program TANF Policy

3. Training units (CAF)

Unit Resource Phone

CAF Child Welfare Training

Unit

Manager

CW Training Specialist

CAF Events Coordinator

FACIS/ORKids Trainers

Administrative Support

Foster Parent Lending

Library

Karyn Schimmels

Judy Helstrom

Sue Ellen Seydel

Deborah Martinmaas

Adelaid Turner

Cynthia Gallegos – NetLink

Brian Hebert – NetLink

Cynthia Gallegos

503-373-7231

503-945-6681

503-945-6687

503-373-7714

503-378-5817

503-373-7838

503-508-6879

503-373-7838

CAF SSP Training Unit

Manager

Lead Trainer

Administrative Specialist/

Training Support

Trainers

Bonnie Murray

Darlene Kelly

Cori Budrow – Web Design

Douglas Bloom

Steve Bradley – NetLink

Karrie Farrell

Darlene Kelly

Terry Kester

Sara Reed (PSU Collaboration)

Glenda Short

Betty Silva

503-569-6472

503-373-1465

503-373-1786

503-373-7881

503-378-6262

503-373-1711

503-373-1465

503-373-7882

503-367-8222

503-373-7818

503-373-1754

FSML – 64D


E. Pat Smith – NetLink

Lori Van Dusseldorp

503-373-1707

503-378-2777

CAF Technical Training Unit

Manager

Administrative Support

Video Conferencing

Technical Trainers

Karyn Schimmels

Cynthia Gallegos – NetLink

Brian Hebert – NetLink

Cynthia („thia) Evans

Jolly Hill

Elizabeth Lair – E-Learning/

NetLink

503-373-7231

503-373-7838

503-508-6879

503-378-6337

503-378-2772

503-373-7869

Domestic Violence Training

Team

Karrie Farrell

Darlene Kelly

Lori VanDusseldorp

503-373-1711

503-373-1465

503-373-1707

ERDC Training Team Lori Van Dusseldorp 503-373-1707

Medical Training Team Terry Kester

Glenda Short

Betty Silva

Lori VanDusseldorp

503-373-7882

503-373-7818

503-373-1754

503-373-1707

Noncitizen Training Team Karrie Farrell

Terry Kester

Glenda Short

Betty Silva

503-373-1711

503-373-7882

503-373-7818

503-373-1754


Assistance Program Training

Team

Douglas Bloom

Karrie Farrell

Betty Silva

503-373-7881

503-373-1711

503-373-1754

SSP E-Learning Training Team Cori Budrow

Terry Kester

Betty Silva

503-373-1786

503-373-7882

503-373-1754

SSP Essentials and SSP

Communication Fundamentals

Training Team

Douglas Bloom

Sara Reed

Glenda Short

503-373-7881

503-367-8222

503-373-7818

SSP Modernization Training Scott Ciullo 503-373-7884

SSP Technical Training Team Steve Bradley 503-378-6262

TANF Training Team Karrie Farrell

Darlene Kelly

Sara Reed

Lori Van Dusseldorp

503-373-1711

503-373-1465

503-367-8222

503-373-1707

TANF Vocational Training Lisa Buss/Amy Sevdy 503-945-7017

4. Other resources

Item Resource Phone

Children: abused,

neglected

CAF Child Welfare (formerly SCF) See “Blue Pages” of a local

phone book

FSML – 64D


Domestic violence Crisis Programs

www.dhs.state.or.us/abuse/domestic/

gethelp.htm

Look under “Crisis” in

your local phone book

Early childhood

education

Oregon Department of Education or

local school district

503-378-5585

See “Blue Pages” of a local

phone book

Health insurance for

low-income families

Office of Private Health Partnerships 800-542-3104


children who are

over-income for DHS

medical programs

Oregon Healthy Kids Connect

Program

888-260-4555 (Toll-Free in

Oregon)

Salem: 503-378-8631

Fax: 503-373-7251


adults and children

who are unable to

obtain medical

insurance because of

health conditions

Oregon Medical Insurance Pool

(OMIP)

Federal Medical Insurance Pool

(FMIP)

800-848-7280

503-225-6620

Fax: 503-225-5474

Assistance for

Oregon families to

pay monthly health

insurance premiums

Family Health Insurance Program

(FHIAP)

888-564-9669 (Toll-Free in

Oregon)

Salem: 503-373-7419

Fax: 866-843-8936

Immigration and

Naturalization

Service Information

General Information 503-326-5930

Medical coverage

information for

women, children, and

teens not eligible for

DHS medical

programs

SAFENET – Statewide

Metro-Portland/Tricounty

Immunization Information

Teen Health Infoline

800-SAFENET

503-306-5858

800-998-9825

Nutrition Information Lauren Tobey 541-737-1017

Rehabilitation for

employment

DHS Vocational Rehabilitation

(formerly VRD)

503-945-5880

877-277-0513 (Toll Free)

TTY: 866-801-0130

Specialized services

for clients: educational

support, I&R, lunch

buddy programs,

mentoring, recreational

activities, resource

locations, seasonal

programs, socialization

programs, special

projects, transportation,

work experience,

AmeriCorps volunteers

DHS Volunteer Services See local DHS Volunteer

FSML – 64D


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FSML – 64D

February 29, 2012 Medical Assistance Programs E – Specific Eligibility Requirements E - 1

E. Specific Eligibility Requirements

1. Medical Assistance Assumed (MAA)

To be eligible for MAA, a client must be a dependent child or a caretaker relative of a

dependent child. However, a dependent child or caretaker relative cannot receive MAA

while foster care payments are being made for the child.

There is one exception. If a child in foster care is expected to return within 30 days, the

caretaker relative may be eligible for MAA based on the expected return of the child.

Confirm the expected return date with CW.

Caretaker relatives can also receive MAA if their only child is an SSI recipient or their

child is ineligible for MAA only because citizenship has not been documented yet.

Either parent whose only child is an unborn child can qualify for MAA if the mother‟s

pregnancy has reached the calendar month before the month in which the due date falls.

The father of the unborn child can receive MAA even before the mother‟s pregnancy has

reached the calendar month before the month in which the due date falls if there is

another dependent child in the filing group.

Example: Mary is pregnant, due in six months. She is living with Dan, the father

of the unborn and her three children from a previous relationship. Dan

is the Primary Wage Earner (PWE). He was laid off from his last job

and receives a small amount of UC, but the family is still under the

MAA income limit. Mary and Dan are not married, but they meet the

two-parent deprivation requirements based on unemployment. Even

though Mary is not due for six months, everyone qualifies for MAA,

including Dan.

A minor parent continues to be eligible for MAA if they lose TANF eligibility because

they refuse to live with a parent or adult relative, or if they go over income due to

deeming when they are required to return to live with a parent. The minor parent must

also continue to meet all other TANF requirements.

People disqualified from TANF only because they have not cooperated with JOBS or

substance abuse/mental health requirements are eligible for MAA as long as they

continue to meet all other TANF eligibility requirements.

Persons serving a TANF or SNAP intentional program violation (IPV) penalty may still

qualify for MAA, even if not pregnant.

Assumed Eligibility for Medical Programs: 461-135-0010

Specific Requirements; MAA, MAF, and TANF: 461-135-0070

FSML – 64D

E - 2 Medical Assistance Programs E – Specific Eligibility Requirements February 29, 2012

2. Medical Assistance to Families (MAF)

When a family or child becomes ineligible for or is denied MAA because of their

household composition or income, determine eligibility for MAF medical assistance prior

to converting to EXT or other OHP Plus medical program.

Family members may be eligible for MAF when ineligible for MAA under the following

situations:

Situation 1: If a blended (yours/mine/ours) family is ineligible for MAA because

of income, resources or other program requirements, eligibility may exist by

forming separate filing groups under MAF.

For MAF, a blended family is one in which there is at least one child or unborn in

common and the parents are unmarried. To fit in situation 1, there must also be at

least one other child in the household from a prior relationship. If the only child is

an unborn child in common, it is a situation 2 family (see below);

Situation 2: A family is over income for MAA because of income from the father

of an unborn child. If the father of the unborn child is not married to the mother

and there are no other dependent children, the mother and the unborn child form a

separate filing group. Deem the father‟s income to the mother. If the father of the

unborn is also the father of another child in the household, consider situation 1.

Do not begin MAF benefits until the calendar month before the month in which

the due date falls. For both MAA and MAF, if the only child is an unborn child,

there is no eligibility until the month before the calendar month in which the due

date falls;

Situation 3: A family is over income for MAA because of income from an

ineligible noncitizen. Eligibility for MAF may exist by deeming the noncitizen‟s

income to the MAF need group.

When deeming the noncitizen‟s income, deduct the payment standard of the people

who do not meet the citizenship or alien status requirements. However, explain to

the family that they may choose not to apply for MAF benefits for one or more of

their noncitizen children. If the family so chooses, deduct the payment standard for

as many noncitizens as are needed to make the balance of the filing group eligible

for MAF benefits.

For example, if there is an adult noncitizen and two noncitizen children who do not

meet the alien status requirements, but only the adult has income, you may choose

to deduct the payment standard for the adult only. The two noncitizen children

may receive MAF CWM.

In families with more than one ineligible noncitizen with income, it is possible to

remove only one of the ineligible noncitizens from the filing group. For example,

in a family with an ineligible noncitizen mother who earns $350 a month, an

ineligible noncitizen father who earns $400 a month and one citizen child, the

FSML – 64D


father can be removed and his income deemed, making the mother MAF CWM

and the child MAF. Or, if more advantageous to the family, the mother and father

can be removed, making the child MAF eligible;

Situation 4: A family is over income for MAA because of income from the spouse

of a needy caretaker relative. The spouse with income is removed to form a

separate MAF filing group. If the spouse has any dependent children, they must be

removed also. Deem the spouse‟s income to the MAF need group.

Situation 5: A family with self-employment income is over income for MAA.

Eligibility for MAF may exist by allowing for actual costs of producing self-

employment income.

SEE COUNTING CLIENT ASSETS C (CA-C) FOR MORE INFORMATION.

Filing Group; EXT, MAA, TANF: 461-110-0330

Filing Group; MAF and SAC: 461-110-0340

Specific Requirements; MAA, MAF, and TANF: 461-135-0070

3. Extended Medical Assistance (EXT)

Family members who are eligible for and receiving MAA or MAF may qualify for a

period of EXT Medical after their eligibility for MAA/MAF ends.

When an MAA/MAF filing group may be eligible for EXT:

The filing group must have become ineligible for MAA/MAF because of an

increase in the caretaker relative‟s earnings or because of child support received.

Do not require verification of the increased earnings or support;

- If another change occurs in conjunction with the increase in the caretaker

relative‟s earnings or in child support received, the filing group is not

eligible for EXT if the other change, by itself, would have made the filing

group ineligible for MAA/MAF.

Example: Anita and her two children, William and Sara, are receiving MAA

when Robert, Anita’s husband, returns to the household. His earned

income puts the family over the income limit for MAA.

The filing group is not eligible for EXT. It was not an increase in the

caretaker relative’s earnings that caused the filing group to become

ineligible for MAA. While Robert is a caretaker relative, it was the

earnings that he already had when he joined the filing group that

made the filing group ineligible (not an increase in his earnings).

FSML – 64D


EXT eligibility period

If eligibility is a result of increased earnings of the caretaker relative, the eligibility

period is for 12 months. Code with the AE2 need/resource item (more on coding

below within this section):

- There is no requirement that the family receive MAA/MAF for three of the

six months prior to the beginning of the EXT period. However, to qualify

for EXT based on increased earnings of the caretaker relative, the person

has to have been eligible for and receiving MAA/MAF;

- If a filing group meets the eligibility requirements for EXT based on a

combination of increased income from the caretaker relative‟s earnings and

child support, even if either increase by itself does not make the filing

group ineligible for MAA or MAF, the filing group‟s eligibility period is

based on increased earnings.

If eligibility is a result of increased income due to child support, the eligibility

period is for four months. For EXT based on an increase in child support, the

following requirements apply:

- At least one member of the MAA/MAF filing must have been eligible for

and receiving MAA/MAF in three of the six months prior to the beginning

of the EXT eligibility period;

- Do not count months the family received Medicaid in another state towards

the three-of-six months requirement;

- Do not count months on EXT towards the three-of-six months requirement;

- The three-of-six month requirement does not have to be consecutive

months;

- If MAA/MAF was received for at least one day in a month, the whole

month is counted.

Retroactive MAA/MAF eligibility counts in determining if the filing group meets

the three-of-six months requirement for a family that goes over the income limits

due to an increase in child support.

SEE MEDICAL ASSISTANCE E. 6 (MA-E.6) FOR MORE INFORMATION ABOUT

DETERMINING ELIGIBILITY FOR RETROACTIVE MEDICAL ASSISTANCE.

Specific EXT requirements

Persons must have been members of the MAA/MAF benefit group when those

benefits ended to be included in the EXT benefit group;

Example: Sally and her son Seth were receiving MAA until Sally received a

promotion which put her over the MAA income limit. They are now

FSML – 64D


receiving EXT. Sally’s daughter Joanne joins the household while

the family is receiving EXT benefits.

Joanne is included in the EXT filing, financial and need group, but is

not included in the EXT benefit group because she was not in the

MAA benefit group when those benefits ended.

Example: Allison’s MAA medical closed because she did not complete her

redetermination. When she reapplied two months later for MAA for

herself and her daughter Janie, she was over income for MAA

because an increase in child support.

Allison and Janie are not eligible for EXT. They received MAA for

three of the previous six months, but she was not receiving MAA

when she went over the MAA income limit due to the increase in

child support.

The filing group must include a dependent child. A filing group is no longer

eligible for EXT if it does not include a dependent child, but may regain EXT

eligibility if it again includes a dependent child;

Members of a benefit group who become ineligible for EXT may regain eligibility

for EXT if they again meet EXT eligibility requirements;

Example: John and his two children became ineligible for EXT because they

moved out of state. They moved back to Oregon and again met the

eligibility requirements for EXT.

John and his children may be eligible to receive EXT for the

remainder of the EXT eligibility period.

Example: Don, Cheri and their daughter Jenny are receiving EXT. Don moved

out of the household. Cheri and her daughter continue to receive

EXT, but Don loses eligibility.

If Don returns to the household, he may regain EXT eligibility for

the remainder of the EXT eligibility period.

EXT CM coding and support

When EXT eligibility is based on increased child support:

EMS with end date = fourth month;

- Enter this N/R when converting a CM case to EXT. The end date should be

the fourth month of the EXT eligibility period;

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- The CM case will automatically close at the end of the fourth month. An

advance close notice and application packet will be mailed to the client

prior to closure.

When EXT eligibility is based on increased earned income:

- AE2 with end date = 12th month;

(a) Enter this N/R when initially converting a CM case to EXT. The

end date should be the 12th

month of the EXT eligibility period. An

EXT approval notice will automatically be mailed to the client.

EXT effective date

If reported timely, start EXT medical the first of the month following the last

month of MAA/MAF eligibility. No 10-day notice is required. Because no 10-day

notice is required, some TANF/MAA cases will convert to TANF/EXT before the

TANF can be closed. An individual can receive TANF and EXT on the same CM

case;

Note: When the family goes over the income due to an increase in child support, make

sure the family has met the “three-of-six” months MAA/MAF criteria.

Example: Paul and Paula have been receiving MAA for the last six months. On

December 30, they report timely that Paul has a new job and they

will be over income for MAA in January. Begin EXT medical

effective January 1.

If an MAA/MAF client does not report an increase in income or child support

timely, they may still be eligible for EXT. The EXT eligibility begins the first of

the month the household went over income for MAA/MAF.

Reminder: The budget month used for the EXT determination is the month the client

timely reports increased earnings or child support that will make them over the

MAA/MAF income limit. If not reported timely, the budget month is the month before

the month the client exceeded the MAA/MAF income limit due to increased earnings

or child support.


Specific Requirements; EXT: 461-135-0095

Eligibility Period; EXT: 461-135-0096

Earned Income; Treatment: 461-145-0130

Dependent Care Costs; Deduction and Coverage: 461-160-0040

4. Medical assistance to children in Substitute or Adoptive Care (SAC)

To be eligible for the SAC program, an individual must be under the age of 21 and:

FSML – 64D


Live in substitute care covered by title IV-E of the Social Security Act;

Live in a foster care or private institutional setting for which a public agency of

Oregon is assuming at least partial financial responsibility;

Live in an intermediate care facility, including an intermediate care facility for

people with mental retardation, or a licensed psychiatric hospital;

Receive independent living subsidy payments from the department to assist the

individual to live independently when foster care payments were discontinued;

Is a child for whom an adoption assistance agreement from another state is in

effect, regardless if a payment is being made;

In a state-subsidized adoptive placement, if an adoption assistance agreement is in

effect between a public agency of Oregon and the adoptive parents indicating

title IV-E or Medicaid eligibility.

A child in substitute care must meet all TANF nonfinancial and financial eligibility

requirements.

Children subject to an adoption assistance agreement described above are assumed

eligible for the SAC program.

When a child moves to Oregon from another state where an adoption assistance

agreement is in effect between an agency in that state and the adoptive parents, the other

state usually sends forms to Oregon‟s DHS Adoption Assistance Unit indicating the

family has moved to Oregon and is eligible for medical assistance. Those forms are

forwarded to the Children‟s Medical Project Team at the Oregon Health Plan branch. The

team establishes medical assistance for the child and notifies the family of the coverage.

Instead of sending adoption agreement forms to the DHS Adoption Assistance Unit, a

few states send the forms directly to the adoptive parents making them responsible for

applying for the child‟s medical assistance at the local branch office. See section B.1.

(MA-B.1), Application for medical assistance, of this chapter for information on the SAC

application process.


Specific Requirements; SAC: 461-135-0150

5. Citizen/Alien-Waived Emergent Medical (CAWEM) medical assistance

To qualify for CAWEM, a person must meet all the nonfinancial and financial eligibility

requirements for another medical assistance program, except the citizen/alien status and

Social Security Number requirements.

FSML – 64D


Exception: There is no CAWEM eligibility under the OHP-CHP category.

You do not need to make a decision about whether the person is in need of immediate

medical treatment or in need of childbirth (labor and delivery) services. Medical

decisions are determined by the person‟s medical provider pursuant to the administrative

rules of the Office of Medical Assistance Programs. If a medical provider has questions

about whether a condition is covered, they should contact DMAP at 800-527-5772.

Medical assistance is authorized under the program (MAA, MAF, OHP and SAC) for

which the person would qualify if they met the citizen/alien requirement. CAWEM

clients will receive a medical coverage letter when their case opens that says:

“COVERAGE IS LIMITED TO EMERGENCY MEDICAL SERVICES.

LABOR AND DELIVERY SERVICES FOR PREGNANT WOMEN

ARE CONSIDERED AN EMERGENCY.”

A child born to a CAWEM mother is an assumed eligible newborn (AEN). Add the

child‟s medical eligibility to the case using the AEN need/resource code.

Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070

OHP-OPU; Effective Dates for the Program: 461-135-1102

6. Retroactive medical assistance

When people are determined eligible for BCCM, MAA, MAF, OSIPM, QMB-DW,

REFM or SAC, they may be eligible for retroactive medical assistance. People

determined eligible for OHP are not eligible for retroactive medical assistance.

Eligible people may qualify for retroactive medical assistance for up to three months

preceding their date of request. For example, if the date of request is August 7 and

retroactive medical eligibility is established, retroactive eligibility begins May 7.

Eligibility is determined on a month-by-month basis. A person may be eligible in any one

or all three of the months.

Except for SSN requirements, cooperation with DCS and JOBS requirements, they must

meet all of the program‟s eligibility requirements for each retroactive month.

People who are eligible for CAWEM because they met all the eligibility requirements

(other than alien status) for MAA, MAF or SAC, are eligible for retroactive medical

benefits as mentioned above. Clients who are eligible for CAWEM through OHP are not

eligible for retroactive medical benefits. This is because there is no eligibility for

retroactive medical benefits for OHP except one working day; therefore, people who

receive CAWEM through OHP would not be eligible for retroactive benefits.

Example: John and his two children, Paul and Marie, were approved for MAA

medical on their date of request, May 13. Marie has unpaid medical

FSML – 64D


bills from February 16. It is determined that the family met financial

and nonfinancial MAA eligibility requirements for each of the three

months (February, March, April) prior to the date of request.

Start medical for Marie on February 16, the date the unpaid medical

expenses incurred. Use the RM case descriptor to indicate

retroactive medical. The rest of the family starts on the date of

request.

Example: Same scenario as above, except that the family did not meet MAA

financial requirements in March or April (they met all requirements

in February).

Start medical on the date of request (May 13). Submit a Request for

Retroactive Eligibility (MSC 148) to CMU for February.

Example: Frank and Mary have a February 15 date of request. They are not

eligible in the initial budget month of February, but the worker floats

the budget month to March and finds they are eligible for MAA

effective March 1. They have a retroactive medical need for

January 10 and February 16.

The worker reviews the family’s MAA eligibility for January and

finds them eligible for MAA on January 10.

Start medical effective March 1. Submit a Request for Retroactive

Eligibility (MSC 148) to CMU for January. There is no retroactive

medical eligibility for February.

Specific Requirements; Retroactive Medical: 461-135-0875

Effective Dates; Retroactive Medical Benefits: 461-180-0140

7. OHP eligibility categories; overview

To qualify for medical assistance under the OHP program, a person cannot:

Be receiving or deemed to be receiving SSI benefits;

Be eligible for Medicare, unless the person is a pregnant woman;

Be receiving Medicaid assistance through another program; or

Be enrolled in a health insurance plan subsidized by the Family Health Insurance

Assistance Program (FHIAP).

OHP includes five categories of people who may qualify for medical assistance. The first

category is used to determine eligibility for nonpregnant adults who are 19 years of age

and older. Eligibility for pregnant women is always determined using the fourth category.

FSML – 64D


There are additional categories used to determine eligibility for children. Always

determine eligibility for children beginning with the second category, OHP-OPC, before

moving on to the other three categories. If the family‟s income exceeds the OHP-OPC

income limit (100 percent), determine if the children might qualify under other

categories, such as OHP-OP6, OHP-OPP or OHP-CHP.

Specific Requirements; OHP: 461-135-1100

8. First OHP category: Oregon Health Plan (OHP-OPU Program)

This category includes uninsured nonpregnant adults who are in a filing group with

income under the (OHP-OPU) 100 percent income limit.

To be eligible for OHP-OPU, a person must be 19 years of age or older and must not be

pregnant. An OHP-OPU person is referred to as a health plan new/noncategorical (HPN)

client.

There are three groups of medical applicants that may be considered for OHP-OPU:

Clients recertifying for OHP-OPU benefits without a break in assistance, and

Clients converting from child welfare medical, BCCM, EXT, GAM, MAA, MAF,

OHP-OPC, OHP-CHP, OHP-OPP, OSIPM, REFM or SAC to OHP-OPU without

a break in assistance;

Persons randomly selected from the OHP Standard Reservation List. To qualify,

the randomly selected person can establish a DOR on or after the random selection

date through 45 days from the date the Oregon Health Plan (OHP) Standard

Reservation List – OHP Application (OHP 7210R) was mailed.

Note: Individuals whose names are added to the Standard Reservation List will be sent

an Application for Oregon Health Plan and Healthy Kids (OHP 7210)

application with the words “7210P” and “confirmation application” on the label.

DHS/AAA offices may receive these OHP 7210 applications. Workers at local

branches should date stamp the applications and forward these applications to

5503. The OHP Statewide Processing Center (Branch 5503) will process these

applications.

SEE WORKER GUIDE #7 (MA-WG#7) FOR MORE INFORMATION ABOUT THE

OHP STANDARD RESERVATION LIST PROCESS.

“Without a break in assistance” means that the OHP-OPU client requesting recertification

established a DOR before their current certification expired.

“Without a break in assistance” also means a client converting from child welfare

medical, BCCM, EXT, GAM, MAA, MAF, OHP-CHP, OHP-OPC, OHP-OPP, OSIPM,

OYA medical, REFM or SAC applied for medical benefits while still receiving their prior

FSML – 64D


medical program benefits. It could also mean that their worker re-evaluated the client‟s

medical eligibility because of a reported change or eligibility review.

Example: John is under age 60 and not receiving any medical benefits. He

calls his local SSP branch office and says he has just been selected

from the OHP Standard Reservation List. The application that was

sent out when John signed up for the reservation list has already

been denied as he had not yet been selected. The designated branch

person adds his DOR to the Reservation List website and tells John

he will get an application in the mail.

Example: John submits a MSC 415F application and says he has an emergent

need for medical. Following his branch’s emergent need process, his

OHP-OPU eligibility is pended. The worker updates the pend

reasons on the Reservation List website.

Example: Later John turns in the pended items. The worker opens his CM

system case, adding an LST need/resource item with John’s

reservation number from the Reservation List website. The worker

also updates John’s reservation on the Reservation List website to

show John has been approved for OHP-OPU.

Example: Tina is a single adult who is not pregnant, has no children, and has

no disabilities. She is currently not receiving benefits under any DHS

medical program and was not randomly selected from the OHP

Standard Reservation List. She may not be considered for OHP-

OPU.

Example: Marvin is a single adult who was selected from the OHP Standard

Reservation List on October 15. He was mailed a letter letting him

know he had been selected and that he needed to establish a DOR

within 45 days of the date the OHP 7210R was mailed. The

OHP 7210R was mailed October 26. On January 15, Marvin called

his local SSP office and asked for medical. He may not be

considered for OHP-OPU.

Example: Curt is a single adult who is receiving OHP-OPU. His certification

ends on August 31. Curt turns his recertification in timely in August.

Since Curt has reapplied timely, he can be considered for OHP-

OPU.

Example: Larry is receiving OHP-OPU and his children are receiving OHP-

OPC. His certification ends on August 31. He turns in his

recertification late on September 1. His family is not eligible for

MAA or MAF. Although his children can be considered for OHP,

Larry cannot be considered for OHP-OPU.

FSML – 64D


Example: Barry was selected from the OHP Standard Reservation List on

July 15. On July 27, Barry submitted an OHP 7210 application to

recertify his children's medical. On the application, he also

requested medical for himself. The eligibility worker checked on the

Standard Reservation List website and found that Barry had been

selected July 15. Using the July 27 DOR, the worker determined that

Barry is eligible for OHP-OPU benefits and opened Barry's OHP

Standard benefits effective July 27.

Example: Mary established a DOR for herself on August 15. The worker

checked on the OHP Standard Reservation List and discovered that

Mary was selected on July 15 and an OHP 7210R will be mailed

September 10. Using the August 15 DOR and the August budget

month, the worker determined Mary was over income for OHP-OPU

in August. Mary indicated her income would drop for September, so

the worker floated the budget month to September and determined

Mary qualified for OHP Standard benefits effective September 1.

Since even an initial full-month prorated month does not count

toward the six month OHP-OPU certification, Mary's certification

end date is March 31, 2011.

Note: For OHP-OPU, if the date of request is on or after March 1, 2011, the OHP-OPU

certification period begins on the effective date for starting medical benefits

(described in OAR 461-180-0090) and includes the following 12 calendar months.

See OAR 461-145-0530 for details about certification periods.

Example: Frank applies for medical on September 1. The worker checks on the

Standard Reservation List website and sees that Frank was mailed

an OHP 7210R on July 15. Since it has been more than 45 days

since the OHP 7210R mail date and Frank is not eligible for any

SSP or SPD program, the worker denies the application and send a

DHS 462A.

Example: Raul calls and establishes a DOR on October 2. Support staff

narrates and sends Raul an application. November 2, Raul’s

application arrives at the branch. The worker sees that Raul has

been selected from the list on October 15. The worker processes

Raul’s application and finds him eligible for OPU. The worker starts

medical on the selection date of Oct 15.

SEE MEDICAL ASSISTANCE CHAPTER B.3 (MA-B.3) VFOR MORE INFORMATION

REGARDING THE REQUIREMENT TO REVIEW FOR ALL MEDICAL PROGRAMS.

In addition to other OHP eligibility requirements, an OHP-OPU client:

Must not be covered by private major medical health insurance. Major medical

health insurance means private or employer-sponsored health insurance that

FSML – 64D


provides inpatient and outpatient medical, physician, lab, x-ray and prescription

benefits for each covered individual;

SEE MEDICAL ASSISTANCE CHAPTER D.9 (MA-D.9) FOR MORE

INFORMATION REGARDING THE FHIAP REFERRAL PROCESS WHEN

HEALTH INSURANCE IS AVAILABLE THROUGH AN EMPLOYER.

Must not have been covered by private or employer-sponsored major medical

health insurance during the six months preceding the effective date for starting

medical benefits. The six-month waiting period is waived if:

- The person has a condition that without treatment would be

life-threatening, or would cause permanent loss of function or disability;

SEE B.7 (MA-B.7) IN THIS CHAPTER FOR INFORMATION ABOUT OMIP/FMIP

AND DHS MEDICAL ELIGIBILITY.

- The person‟s private or employer-sponsored health insurance premium was

reimbursed under the provisions of OAR 461-135-0990;

- The person‟s private or employer-sponsored health insurance premium was

subsidized through FHIAP; or

- A member of the person‟s filing group was a victim of domestic violence.

Note: OPU applicants receiving services through Indian Health Services or who have

TPL that the tribe pays for are still eligible for OPU.

Some applicants who receive medical benefits through the Veterans‟

Administration (VA) are not eligible for OHP. VA benefits are considered major

medical. There are VA hospitals in Portland and Roseburg. There is also a VA

hospital in Walla Walla, used by many Oregon veterans. There are clinics in

Eugene, Bandon, Salem, Klamath Falls, Brookings, Bend, White City and

Warrenton. If an applicant has access (or has had access in the prior six months) to

care through a local VA facility (including the Walla Walla hospital), they are

usually not eligible for OHP benefits. If the client says the hospital or clinic is not

accessible or says that the Veterans‟ benefits do not cover their medical needs,

then the client may be OPU eligible. If you are not sure, contact a medical policy

analyst;

Must meet the following eligibility requirements:

- OHP resource limit;

- OHP budgeting requirements (using only the two-month income average to

determine eligibility unless DV);

- Payment of premiums unless exempt.

FSML – 64D


Higher education students. Effective January 1, 2012, applicants are no longer required to

meet the student status eligibility criteria for OHP-OPU.

This change does not eliminate the need to review educational income when determining

eligibility.

Certification Period; HKC, OHP: 461-115-0530


OHP-OPU; Effective Dates for the Program: 461-135-1102

Reservation Lists and Eligibility; OHP-OPU: 461-135-1125

Effective Dates; Initial Month Medical Benefits: 461-180-0090

Oregon Health Plan Program premiums. When an OHP-OPU benefit group includes one

or more nonexempt persons, a monthly premium is billed to the household. All clients

eligible for OHP-OPU, if not exempt, are responsible for payment of premiums. Clients

are exempt from paying a premium if they meet one of the following:

Have OHP countable income at 10 percent or less of the Federal Poverty Level.

Clients may become exempt due to income when their OHP is recertified. They

may also become exempt within a certification, but only when the benefit group‟s

OHP income is reduced to 10 percent or less of the FPL when an OHP-OPU client

leaves the benefit group or when two OHP certified households are combined

during a certification;

American Indians and Alaska Natives – American Indian/Alaska Native tribal

membership or eligibility for benefits through an Indian Health Program (HNA

Case Descriptor);

Are CAWEM (CWM Case Descriptor) eligible only.

Note: To waive OHP past-due premiums at recertification for clients with HPI income

at 10 percent of less of the FPI, enter a “WE” in the WAIV field on the UCMS

screen. The WE coding only works at recertification and only if the FPL is

10 percent or less of the FPL. Do not adjust or waive premiums during a

certification because of income changes.

Once the amount of the premium is established, the amount does not change during the

certification period unless one of the following occurs:

An OHP-OPU client becomes pregnant;

A client becomes eligible for OHP-OPU following her assumed eligibility period

as a pregnant female;

An OHP-OPU client becomes eligible for another medical assistance program;

An OHP-OPU client leaves the benefit group;

OHP cases are combined during their certification periods.

FSML – 64D


Note: To adjust premiums when converting from OHP-OPU to an OHP Plus program

or when adding an HNA case descriptor, use the MMIS premium panel.

Instructions for how to adjust/waive premiums on MMIS are available on the SSP

medical tool website in the MMIS section.

A premium is considered paid on time when the payment is received by the OHP Billing

Office on or before the 20th

day of the month for which the premium was billed. The day

the payment arrives in the OHP Billing Office‟s post office box when it is sent via mail,

or the day it is submitted via phone or online to the billing office is the date it is received.

A premium not paid on time is in arrears. All past due premiums and premiums in arrears

for a filing group must be paid before a client can establish a new certification period.

Note: Once determined eligible, OHP-OPU clients cannot be found ineligible for

benefits during a certification period for failure to pay past due premiums. Past

due premiums only affect eligibility at recertification.

A nonexempt OHP-OPU client can be found ineligible for not paying premiums as

follows:

An OHP-OPU applicant who does not resolve unpaid premiums during the

application processing time frame is denied or closed;

Determining eligibility for OHP-OPU applicants with unpaid premiums. When applying

or reapplying under the OHP-OPU program, a nonexempt applicant must pay all billed

premiums to be eligible. Premiums must be paid before the applicant can be recertified.

Include the requirement to pay premiums on the pend notice. If the unpaid premiums are

not resolved within the 45 days from the date of request, deny or close OHP-OPU

medical assistance for that applicant.

Past arrearage can be canceled if the arrearage was incurred while the person was exempt

from the requirement to pay a premium. Clients with OHP countable income of

10 percent or less of the FPL when the premium is calculated at certification, American

Indians and Alaska Natives, and clients eligible under the CAWEM program are exempt.

The department will not attempt collection on any arrearage that is over three years old.

Updating the CM case

If exempt from paying premiums, code “WE” in the WAIV field on the UCMS screen.

If the premiums have been paid or adjusted to zero, but the CM case still has a “K”

premium status, use the “CD” waiver code to bypass the online edits. If you do not use

the WE or the CD coding, the OHP-OPU‟s medical will end during overnight processing.

Premium Requirement; OHP-OPU: 461-135-1120

The computer determines the amount of the monthly premium by determining the

number of persons in the need group, their average monthly income, and the number of

nonexempts in the benefit group.

FSML – 64D


The following table may be used to calculate the premium amount:

OHP PREMIUM by FPL

Number in

Need Group

Percentage FPL Premium Amount Billed for Each

Nonexempt OPU Client

< 10% to 50%

50% to 65%

65% to 85%

85% to 100%

9.00

15.00

18.00

20.00

OHP PREMIUM EXEMPT BY INCOME AMOUNT

Number in Need

Group

10% FPL Income Limit

(income must be equal to or less

than 10% FPL to be premium

exempt)

1 $ 93.08

2 126.08

3 159.08

4 192.08

5 225.08

6 258.08

7 291.08

8 324.08

9 357.08

10 390.08

+1 +33.00

OHP Premium Standards: 461-155-0235

Premiums are collected by the Oregon Health Plan Premium Billing Office. OHP

premium bills will state where and how to send in payments.

By mail:

OHP Premium Billing Office

PO Box 1120

Baker City, OR 97814

Payments should be made by check, money order or cashier‟s check or over the phone

using Visa, MasterCard or Discover. People who come to a branch office wanting to pay

their premiums should be told to send payments to the above address. Their premium

FSML – 64D


notice includes a return envelope. For questions about the billing (whether a payment was

received, etc.), call the OHP Billing Office at one of the numbers listed on the billing

notice toll-free 888-647-2729, or TTY: 866-203-8931.

9. Second OHP category: Oregon Health Plan for Children (OHP-OPC)

These are persons under the age of 19 in a filing group with income under 100 percent of

the income limit. If income is at or above 100 percent, the person may qualify at either

the OHP-OP6 (133 percent) or OHP-CHP (201 percent) level. However, assumed eligible

newborn children under the age of one who are at or above the OHP-OP6 (133 percent)

are to be coded OHP-OPP and not OHP-CHP.

10. Third OHP category: Oregon Health Plan for Children Under Age 6 (OHP-OP6)

These are persons under the age of six in a filing group with income over the OHP-OPC

(100 percent) income standard, but below the OHP-OP6 (133 percent) income limit.


11. Fourth OHP category: Oregon Health Plan for Pregnant Females Under

185 Percent and Their Newborn Children Under One Year of Age (OHP-OPP)

This category includes pregnant females in a filing group with income below the

185 percent income limit and their assumed eligible newborn children at or above the

OHP-OP6 (133 percent) income limit.


12. Fifth OHP category: Oregon Health Plan for Children (OHP-CHP)

These are persons who may qualify for medical assistance under the Children‟s Health

Insurance Program (CHIP). The CHIP program is not a Medicaid Title XIX program, but

is provided through another federal program, title XXI, which was a provision of the

federal Balanced Budget Act of 1997. They are under the age of 19 who are not eligible

under the OHP-OPC, OHP-OP6 or OHP-OPP categories. The financial group‟s income

must be over the OHP-OPC (100 percent) income limit for children ages 6 through 18 or

over the OHP-OP6 (133 percent) income limit for children under age 6 or over the OHP-

OPP (185 percent) income limit but below the OHP-CHP (201 percent) income limit.

OHP-CHP persons must meet all the following requirements:

Must provide or apply for an SSN;

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Verification of Citizenship or alien status requirements;

Must not be pregnant with income less than 185 percent (code OHP-OPP if

pregnant and less than 185 percent of the FPL);

Pregnant children (under age 19) with income from 185 percent to 201 percent of

the FPL may receive CHIP. Do not forget to add the new CDU (CHIP DUE)

need/resource item, unborn child and father of the unborn to the CHIP child‟s CM

case;

Note: Eligibility for pregnant CHIP women is limited. If the pregnant CHIP woman

loses CHIP eligibility at redetermination (turning age 19 or at the end of the

CHIP 12 month certification), convert to Continuous Eligibility for CHIP

pregnant children.

SEE SECTION 16 BELOW FOR MORE INFORMATION ABOUT CONTINUED

ELIGIBILITY FOR CHIP PREGNANT CHILDREN.

Note: Children born to pregnant CHIP women are assumed eligible for Medicaid for

one year. Code the child as an MAA AEN on the CM case.

With a few exceptions listed below, the child must not be covered by major

medical health insurance. Major medical health insurance means health insurance

coverage that includes inpatient and outpatient hospital, lab, x-ray, physician and a

prescription benefit;

Do not delay CHIP eligibility solely because the child is covered by Kaiser Child

Health Program or Kaiser Transitions Program medical. Kaiser will end their

medical after the CHIP medical eligibility is opened;

Note: Effective March 26, 2010, the OHP Statewide Processing Center (Branch 5503)

will process SSP applications for children in Kaiser Permanente’s Child Health

Program or Transitions Program. Fax the application to 5503 at 503-373-7493.

A cover letter was developed to support the process. Be sure to include the

“Attention” cover letter when faxing the application. The cover letter will be

posted to the SSP medical website the week of March 29.

Do not delay CHIP eligibility solely because the child is receiving services

through Indian Health Services. Be sure to send HIG a Notification of Other

Health Insurance (MSC 415H) form with the Indian Health Service coverage

information. Include the information that the coverage does not affect CHIP

eligibility;

Note: In some instances, the state can recover pharmacy costs for individuals who are

covered under Indian Health Services coverage and for that reason, it is reported

to HIG on an MSC 415H.

For children who are eligible for CHIP and have been covered by private or

employer-sponsored major medical health insurance, verify the TPL has ended

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before opening CHIP benefits. To verify the TPL has ended, the worker can call

the employer or the insurance company or ask for a copy of the policy cancellation

letter. If more information about the insurance provider is needed, i.e., phone

number or policy number, workers can request a copy of the insurance card or

have the client complete the MSC 415H form;

Unless covered by Kaiser Child Health Program, Kaiser Transitions Program or

Indian Health Services, the child must not have been covered by any private or

employer-sponsored major medical health insurance in the past two months. The

two-month waiting period is waived if any of the following are true:

- The person has a condition that without treatment would be life-threatening

or cause permanent loss of function or disability (accept the client‟s

statement);

- The loss of health insurance was due to a change in employment (includes

children whose COBRA coverage has ended or whose parents choose to

end COBRA coverage);

- The person‟s private health insurance premium was reimbursed by a PHI

(Private Health Insurance) payment;

- The person‟s employer-sponsored health insurance premium was

reimbursed by HIPP (Health Insurance Premium Payment);

- The person‟s private health insurance premium was subsidized by FHIAP

or by the Office of Private Health Partnerships (OPHP);

- A member of the filing group was a victim of domestic violence.


Note: Remember the parents of CHIP children should never be forced to apply for,

accept and maintain other health insurance coverage as this is not an eligibility

requirement in the CHIP program like it is in Medicaid.

When a person is in a hospital and becomes ineligible for OHP because they no longer

meet the age requirement for their category, they can continue to be eligible for OHP

until the end of the month in which they are discharged from the hospital.

13. Third-Party Insurance, Health Insurance Premium Payments (HIPP) and Private

Health Insurance (PHI) reimbursements

Third-Party Insurance (TPL) – Private or employer-sponsored insurance

When a client is identified as having private or employer-sponsored health insurance, it

must be added to MMIS because Medicaid, in most cases, is the payer of last resort.

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Other insurance is also known as third-party resources, third-party liability (TPL) and

health care coverage (HCC).

The Health Insurance Group (HIG) verifies third-party insurance policies and then

updates MMIS. HIG also:

Adds a TPL exemption to MMIS so clients with TPL are not auto-enrolled into a

managed health care plan (FCHP or PCO). HIG does not add TPL exemptions for

dental or mental health plans unless they are specifically requested by DMAP.

TPL exemptions only prevent auto-enrollment. They do not prevent manual

enrollment. Before enrolling, workers should check MMIS to be sure clients are

not already enrolled, have an active exemption or have active TPL;

Disenrolls clients from managed health care plans (effective the end of the month

the insurance is identified) when they are determined to have active private or

employer-sponsored health insurance.

Note: TPL exemptions only prevent auto-enrollment. They do not prevent manual

enrollment. Before enrolling, workers should check MMIS to be sure clients are

not already enrolled, have an active exemption or have active TPL.

If the client is already enrolled in an FCHP or PCO, HIG disenrolls the client from the

plan effective the last day of the month.

MSC 415H – Notification of Other Health Insurance form

Clients are required to report to the department when members of their household who

are receiving or applying for Medicaid have other insurance. This is done by completing

the Notification of Other Health Insurance form (MSC 415H). Once completed by the

client or a worker, the MSC 415H is sent to the Health Insurance Group (HIG). HIG

verifies the insurance with the insurance carrier and updates the TPL file in MMIS. The

MSC 415H should be sent to HIG for new insurance and when existing insurance ends or

changes.

MSC 156 – Request for Rush Verification of Third Party Insurance form

If a client is having an emergency and is unable to get prescriptions or other medical

services due to inaccurate TPL information in MMIS, a worker can request “Rush”

processing by emailing the MSC 156 form to HIG to TPR REFERRALS. In most cases

rush requests are done the same day they are received.

Health Insurance Premium Payment (HIPP)

In some situations, the state will reimburse policy holders for the amount of the premium

they pay for their private or employer-sponsored medical insurance when the policy

covers an individual who is eligible for a medical assistance program (except CEC, OHP-

CHP and OHP-OPU), and it is cost-effective for the state. Self-employed people who

have group health insurance may also be reimbursed if determined cost-effective.

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To qualify, the person‟s health insurance must be a major medical plan which includes

physician and hospital services, doctor visits, lab and x-ray and a full pharmacy benefit.

Examples of major medical plans are: a Health Maintenance Organization (HMO); a

Preferred Physicians Care Organization (PCO); a Point of Sale Plan (POS); or an

Indemnity Health Insurance Plan. Examples of what would not be a major medical plan

are: Medicare supplements, accident or replacement policies.

Effective November 1, 2011, eligibility for the HIPP program is determined by the

Health Insurance Group (HIG) and not the branch offices. This means that workers will

not be able to issue HIPP payments through the CM system, OR ACCESS or using

Special Cash Pay (437). Workers use the MSC 415H to make HIPP referrals to HIG.

DMAP does not pay Health Insurance Premium Payments (HIPP) for:

Non-SSI institutionalized and waivered clients whose income deduction is used for

payment of health insurance premiums;

Vision, dental or long-term-care policies;

Clients covered by Medicare.

For information about the HIPP program including details on the referral and

determination process, please see the DMAP worker guide.

Payment of Private Health Insurance (PHI)

In special situations, DMAP may pay for insurance premiums even if the premium is

greater than what is allowed on the HIPP Medical Savings Chart. This may occur when

the cost for an individual‟s health services is less than the estimated cost of paying for

those services on a fee-for-service (FFS) basis. The Health Insurance Group (HIG)

administers the PHI program and determines program eligibility. HIG may request

medical documentation or copies of Explanation of Benefits (EOBs) before PHI can be

approved. Payments for PHI generally go directly to the insurance carrier; however, in

some cases, payments may be paid directly to the policyholder. The health insurance may

be a private individual family policy or employer-sponsored insurance. The PHI program

is for physical health policies only.

DMAP does not pay PHI premium payments for:

Non-SSI institutionalized and waivered clients whose income deduction is used for

payment of health insurance premiums;

Clients eligible for HIPP;

Vision, dental or long-term-care policies;

Clients covered by Medicare.

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For information about the PHI program including details on the referral and

determination process, please see the DMAP worker guide.

SEE DMAP WORKER GUIDE # 7 FOR MORE INFORMATION.

Client‟s Rights and Responsibilities: 410-120-1855

Payment of Private Insurance Premiums: 410-120-1960

Medical Assignment: 461-120-0315

Requirement to Pursue Assets: 461-120-0330

Clients Required to Obtain Health Care Coverage and Cash Medical Support; CEM, EXT, GAM, MAA,

MAF, OHP (except OHP-CHP), OSIPM, SAC: 461-120-0345

Clients Excused for Good Cause from Compliance with OAR 461-120-0340 and 0345: 461-120-0350

Specific Requirements; Reimbursement of Cost-Effective, Private or Employer-Sponsored Health

Insurance Premiums: 461-135-0990

Changes That Must be Reported: 461-170-0011

Effective Dates; OHP Premium: 461-180-0097

Personal Injury Claim: 461-195-0303

14. Using Express Lane Eligibility (ELE) for children in the OHP-OPC and OHP-CHP

programs

The CHIP Reauthorization Act of 2009 provided the option for states to implement

Express Lane Eligibility (ELE) for Medicaid and CHIP. ELE allows states to borrow

some eligibility findings from other agencies approved by the Oregon Health Authority

(OHA) as Express Lane Agencies (ELA), such as WIC and SNAP, and to use those

agencies‟ findings to determine medical eligibility for children.

Effective August 2010, OHA/DHS implemented SNAP ELE. In November 2011,

OHA/DHS began to pilot ELE in five school districts using the National School Lunch

Program (NSLP) as an ELA.

ELA findings will be used only at the OHA Statewide Processing Center

(Branch 5503).

NSLP and SNAP income calculations will be used to determine eligibility for the OPC

and CHP programs for children in filing groups where no one is receiving medical

assistance. Cases are placed in OPC or CHP as follows:

Children with SNAP or NSLP income below 163 percent of the federal poverty

level (FPL) are placed in the OPC program;

Children with SNAP or NSLP income at or above 163 percent FPL are placed in

the CHIP program.

Note: If the parents also request medical, the 5503 worker will use the ELA findings to

determine whether the child is OPC or CHP and open medical in the appropriate

program. The 5503 worker will then pend for information needed for MAA/MAF.

If the parents return the pended information and are eligible for MAA/MAF,

MAA/MAF will be opened for the family. If the parents do not respond to the pend

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or are not eligible for MAA/MAF, staff will leave the children on OPC or CHP

based on ELE.

New case descriptors, Express Lane SNAP (ELS) and Express Lane NSLP (ELL) have

been created to identify the children found eligible based on an ELA determination.

Using ELE, verification requirements are reduced or eliminated. The following eligibility

factors must still be verified:

Citizenship (open with CIP coding if needed);

Health Insurance information for children eligible for OPC.

Reminder: Children covered by private major medical health insurance are ineligible for

CHIP. When the child is found to have SNAP or NSLP income at or above 163 percent of

the FPL but the child has other health insurance, they cannot be enrolled in CHIP. Prior

to denying or closing medical for the child, the eligibility worker will need to determine

medical eligibility based on current Medicaid or CHIP policy.

There are reduced verification requirements for:

Absent parent information;

Identity (a parent‟s signature on a SNAP application is sufficient for children

under age 16).

There are no verification requirements for the SNAP or NSLP program findings of:

Income;

Filing group size;

SSN;

Residency.

The following eligibility factors must still be verified by the 5503 worker:

Citizenship;

Health insurance information for children eligible for OPC.

Definitions for Chapter 461: 461-001-0000


Eligibility and Budgeting; HKC, OHP: 461-150-0055

Poverty Related Income Standards; Not OSIP, OSIPM, QMB: 461-155-0180

Income Standard; HKC, OHP, REFM: 461-155-0225

Use of Income; HKC, OHP: 461-160-0700

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15. Breast and Cervical Cancer Treatment Program (BCCTP)

The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Public

Law 106-354) amended Title XIX (Medicaid) of the Social Security Act to give the

option of providing Medicaid eligibility to uninsured women who are screened by the

Centers for Disease Control and Prevention‟s National Breast and Cervical Cancer Early

Detection Program (NBCCEDP) and are in need of treatment for breast or cervical

cancer, including precancerous conditions.

Effective January 1, 2012, women with qualifying breast or cervical cancer diagnoses,

including specific precancerous conditions, who meet the eligibility criteria for the Breast

and Cervical Cancer Program (BCCP) will be eligible for treatment through BCCTP.

Women no longer need to be diagnosed by a specific BCCP provider, but can be

presumptively enrolled by a licensed health care provider.

The Oregon Breast and Cervical Cancer Program reimburses local medical providers and

tribes throughout the state to administer screening and diagnostic services.

Eligibility requirements for BCCTP

There are no financial eligibility requirements for BCCTP once a woman has been

determined by a qualified provider to meet the BCCTP criteria.

To be presumptively eligible for BCCTP, a woman must:

Be an Oregon resident;

Be a U.S. citizen or have lawful residential status;

Have a household income at or below 250 percent FPL;

Have been diagnosed as needing treatment for breast or cervical cancer, or specific

precancerous conditions;

Be under the age of 65;

Be uninsured. She must not have creditable coverage for the needed treatment of

breast or cervical cancer, or precancerous conditions, by health insurance.

Creditable coverage includes:

- Individual or group health insurance;

- Medicare;

- Medicaid;

- Armed forces insurance;

- Family Health Insurance Assistance Program (FHIAP);

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- Oregon Medical Insurance Pool (OMIP).

Not be eligible under any of the mandatory Medicaid programs (MAA, MAF,

Medicaid for pregnant women and children or OSIPM).

Definitions for Chapter 461: 461-001-0000

Age Requirements for Clients to Receive Benefits: 461-120-0510

Application for BCCTP

BCCTP eligibility is determined through the licensed health care provider, and is not

determined by OHA eligibility staff.

When an uninsured woman is found to need treatment for either breast or cervical cancer

or precancerous conditions after being screened by a licensed health care provider, the

application process is initiated by the provider.

The Breast and Cervical Cancer Treatment Program (BCCTP) Application and Referral

Form (OHA 1463) is completed by a woman who has been screened by a medical

provider and is found to need treatment for breast or cervical cancer, or precancerous

conditions. The provider assists the woman in completing the patient section of the

application. The provider must also complete and sign the provider section of the

application.

The provider determines the woman to be presumptively eligible for BCCTP and submits

the BCCP application form to the Statewide Processing Center (Branch 5503) to establish

eligibility. If it appears the woman could be eligible for a mandatory Medicaid program,

Branch 5503 will assist the woman in getting an Application for the Oregon Health Plan

and Healthy Kids (OHP 7210) from the application center. The OHP 7210 will be

marked “BCP” on the label. If a woman submits the OHP 7210 to a branch office, it is to

be forwarded to the Statewide Processing Center.

Note: If a client receiving benefits under another state's Medicaid Breast and Cervical

Cancer program is moving to Oregon and inquires about Oregon's program,

refer the client to OHA at 971-673-0581 (staff only) or 877-255-7070 (clients) to

ask about the Oregon Breast and Cervical Cancer Treatment Program. OHA

needs direct contact with the client to determine if she meets the criteria for

Oregon's program and to coordinate treatment services, if eligible.

Coding

A woman eligible for the BCCTP program will have her case coded as program P2 with a

BCP case descriptor. A woman who has been determined to be presumptively eligible for

BCCTP but is eligible for another Medicaid program will have her case coded with that

program coding and with a BCS case descriptor.

A woman initially found eligible for BCCTP may be required to complete and return an

OHP 7210 or other DHS application to determine if the woman is eligible for another

Medicaid program. This OHP 7210 application will be marked “BCP” on the label. If the

FSML – 64D


woman submits the OHP 7210 to a branch office, it should be forwarded to the Statewide

Processing Center.

A woman found eligible for the BCCTP program will have her case coded as program P2

with a BCP case descriptor. If the woman is later determined to be eligible under any of

the mandatory Medicaid programs, her case will be coded with that program coding and

with a BCS case descriptor.

A woman who loses eligibility for another medical program, but has her case coded with

the BCS case descriptor, is still eligible for BCCTP as long as she still needs treatment

and continues to meet all other eligibility requirements for the program.

When BCCTP Eligibility Ends

A woman is no longer eligible for the BCCTP program when:

Her course of treatment has been completed;

She reaches age 65;

She becomes covered for treatment of breast or cervical cancer by credible health

insurance;

She is no longer a resident of Oregon.

For information regarding the screening and diagnostic services of the Oregon Breast and

Cervical Cancer Program, contact the local county health department or call DHS Health

Services at 971-673-0581. Information about the program can also be found on the

program's Web page at http://www.healthoregon.org/bcc.

Retroactive Medical Benefits

Clients who are eligible for BCCTP are also potentially eligible for retroactive medical

benefits.

16. Twelve-month continuous eligibility for non-CAWEM children

Effective October 2009, non-CAWEM children under age 19 who lose eligibility for

EXT, CW medical, MAA, MAF, OHP, OSIPM or SAC medical may qualify for medical

under the Continuous Eligibility for Medicaid (CEM).

CEM eligibility overview

Begin continuous eligibility for Medicaid (CEM) when the child:

Was eligible for and receiving EXT, CW medical, MAA, MAF, OHP or OSIPM,

but lost eligibility for the program before the child was able to receive Medicaid

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for 12 full months from their most recent eligibility decision (either the initial

eligibility decision or from the most recent redetermination).

To qualify for CEM, the child must also:

Be under age 19;

Meet the alien status requirement for medical.

Note: Effective October 2009, LPR children (under age 19) meet the alien status

requirement and qualify for full Medicaid and CHIP benefits without having to

wait for five years.

LPR children turning age 19 may no longer qualify for full medical program

benefits. When a child is turning age 19, determine if the 19-year-old’s LPR

status began less than five years ago. If it began less than five years earlier,

consider eligibility for CAWEM benefits.

SEE THE WORKER GUIDE NC-1 (NC-WG#1) FOR MORE INFORMATION ABOUT

IMMIGRATION STATUS REQUIREMENTS FOR MEDICAL.

CEM benefits end when:

They have received Medicaid for 12 straight months since their most recent

eligibility decision (either the initial eligibility decision or from the most recent

redetermination);

The child moves out of state;

The child turns age 19;

The family voluntarily requests the medical be closed.

Procedures and examples

When a child is determined no longer eligible for EXT, MAA, MAF, OHP, OSIPM and

SAC, review for all medical programs as per the usual „due process” procedure.

SEE MA-B FOR MORE INFORMATION ABOUT THE REDETERMINATION PROCESS

AND ACTING ON REPORTED CHANGES.

If found ineligible for EXT, MAA, MAF, OISPM, OHP, QMB and SAC medical

programs, consider if the child is a U.S. citizen or meets the Medicaid/CHIP alien status.

If the child is a U.S. citizen or meets the Medicaid/CHIP immigration status,

convert to CEM for the remainder of the 12 months. Enter the CEM (Continuous

Eligibility for Medicaid) need/resource item and case descriptor. For the CEM end

date, use the end of the 12-month period (counting from either the initial eligibility

decision or from the most recent redetermination);

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Example 1: Regina is receiving OP6; her certification is due to end

November 30, 20XX. On June 10, Regina turns six years of age. A

redetermination is initiated, and Regina’s household now has

income over 201 percent of the FPL. The worker determines

Regina is only eligible for Continuous Eligibility for Medicaid

(CEM). The worker codes Regina with the CEM case descriptor

and need/resource for 11/20XX.

Example 2: Seth is receiving MAA. His LPR status date is January 2008. His

MAA redetermination need/resource end date is January 31, 20XX.

On October 2, Seth’s mother reports that her husband has

returned home and that he earns about $3,000 a month. Acting on

the reported change, the worker determines that the family is not

eligible for EXT, MAA, MAF, OHP, OSIPM or SAC and ends

medical for the mother (sending a 10-day close notice and Notice

of Medical Assistance Program Eligibility Decision (DHS 462A)).

The worker reviews Seth’s eligibility and finds Seth is eligible only

for Continuous Eligibility for Medicaid (CEM). The worker enters

the CEM case descriptor and CEM need/resource item for

01/20XX.

Example 3: Mark and his two children are receiving MAA. No one meets the

disability criteria for OSIPM presumptive. Mark reports an

increase in child support that makes the family ineligible for MAA.

The worker converts the family to EXT for August 1, 2009, through

November 30, 2009.

In November, the worker redetermines medical eligibility for the

family and learns that Mark has a new job with health insurance.

No one in the family is eligible for MAA, MAF, OHP (or OSIPM or

SAC). The children are converted to CEM. The worker enters the

CEM case descriptor and CEM need/resource item on each CEM

eligible child. The CEM need/resource end date is July/2010

(12 months from when the EXT began).

Example 4: Maria and her two children, Consuela and Antonio live with

Antonio’s father. Maria and Antonio’s father are not married.

They are over income for two-parent MAA, so Maria and Consuela

receive MAF CAWEM (redetermination due April 30, 20XX), while

Antonio receives OPC CAWEM (certified through March 31,

20XX).

Maria reports March 5 that she won her UC hearing and her UC

has just begun. The UC amount exceeds the MAF income limit.

The worker reviews eligibility for MAF and OPC and determines

that the family is over income for MAA, MAF, OHP and ineligible

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for OSIPM. The worker realizes that neither child is eligible for

CEM because they do not meet the alien status requirement. The

worker sends a 10-day close notice and Notice of Medical

Assistance Program Eligibility Decision (DHS 462A) and ends

MAF and OPC effective March 31.

Procedures for CEM children turning age 19:

CEM: Children turning age 19 are no longer eligible for Continuous Eligibility for

Medicaid (CEM) unless pregnant. If pregnant, the CEM child will receive benefits

through the end of the second month following the DUE date.

CEM children who are not pregnant will be sent advance and final medical close notices

automatically by the CM system. The CM system will end their benefits at the end of the

month following their 19th

birthday.

CEM children will be mailed advance and final close notices and a reapplication packet.

If there is a date of request (DOR) established before the CEM ends, add a BED code.

Review for medical program eligibility and convert to a new program or end medical

benefits with a 10-day close notice and DHS 462A.

CEC eligibility overview

Begin Continuous Eligibility for CHIP (CEC) when the child:

Is pregnant;

Is eligible for and receiving CHIP; but

Loses eligibility for CHIP for a reason other than private major medical insurance.

The CHIP pregnant woman who loses her eligibility for a reason other than private major

medical insurance should be reviewed for possible OPP or another Medicaid program

first. If the only program the CHIP pregnant woman is eligible for is CEC, convert from

CHIP to CEC.

CEC benefits end when:

Pregnancy ends;

They move out of state;

They request to close medical; or

Private major medical insurance begins.

A pregnant child receiving CHIP with household income from 185 percent up to

201 percent will have a new need/resource code; CDU. The need/resource date will be

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the month the pregnancy is due to end. This is different from a child who is pregnant with

household income below up to 185 percent FPL: that child will be coded OPP.

If the CDU date (CHIP Due date) is on or before the 15th

of the month, the CEC end date

is the same month as the CDU end date.

If the CDU date is after the 15th

of the month, the CEC end date will be the next month to

allow for 10-day notice.

When notified the baby has been born to a woman coded CEC, add the BED coding to

the mother and initiate a redetermination of eligibility.

Example 1: Bailey is age 17, receiving CHIP, and pregnant with a CDU (due)

date of 3/23/10. Her CHIP certification end date is November

2009. At recertification, the family’s income is over the CHIP

income limit. The worker converts Bailey to CEC with a

need/resource of March 2010. Bailey’s CEC will end at the end of

March 2010 unless she initiates a redetermination and is eligible

for medical at that time.

Example 2: Amanda is age 18, pregnant and due December 2009. She is coded

with a CDU for December 2009. Her CHIP benefits began in

August 2009; she is coded CHP with a redetermination date of

July 2010. Her baby is born in December. Because this child is

still age 18 when the baby is born, she continues as CHP with a

redetermination date of July 2010. However, Amanda turns age 19

in February 2010. Because she is no longer pregnant, and is now

19 years of age, her benefits will end. She must be considered for

other medical programs prior to closing or reducing benefits.

Example 3: Shelby, an 18-year-old child is pregnant with a due date of

February 23, 2010. She is currently receiving CHIP and scheduled

for a redetermination in June 2010. In December 2009, she turns

age 19. Because she is 19, she is no longer eligible for CHIP. The

worker determines the only program she is eligible for is CEC. The

worker changes her program to CEC (with a CDU date of 2/2010).

However, because the due date is past the 15th

of the month, the

CEC date is the following month, or 3/2010, to allow time for

notice. When the baby is born, her CEC benefits will end. She may

be eligible for another medical program at that time.

Example 4: Tara is 18 years old and receiving CHIP with household income

from 185 percent up to 201 percent of the FPL, and with a

redetermination date of December 2009. In August 2009, she

brings in proof of pregnancy; she is not due until March 2010. She

is coded CHP with a redetermination date of 12/2009 and also

CDU with a due date of 3/2010. At her December redetermination,

it is determined her household income is now above 201 percent

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FPL. The worker codes her CEC of March 2010, and CDU for

March 2010.

Example 5: Bethany, an 18-year-old who is pregnant with a due date of March

2010, is receiving CHIP and scheduled for redetermination in June

2010. Bethany receives major medical health insurance through an

absent parent in December 2009. She is no longer eligible for

CHIP, and is not eligible for CEC due to the major medical health

insurance. The worker closes her benefits December 2009 after

sending a timely closure benefit notice DHS 462A.

Special 5503 OP6 procedure:

The OHP Statewide Processing Center (Branch 5503) currently receives a monthly report

of children turning age 6. Staff from 5503 will review the report and redetermine

eligibility for each OP6‟s filing group. The procedure will remain, but be expanded to

include Continuous Eligibility for Medicaid.

Example: Chad is a U.S. citizen. He is certified to receive OP6 through

June 30 of next year. Chad turns age 6 in February. In January, the

OHP Statewide Processing Center (5503) receives a report of OP6

children turning age 6. 5503 staff review Chad’s eligibility to

determine if he qualifies for any other DHS medical program. If not

eligible for any other DHS medical program, 5503 will convert Chad

to Continuous Eligibility for Medicaid (CEM) by adding the CEM

case descriptor and need/resource item. The CEM end date will be

06/XX (the original OP6 certification end date).

Special 5503 MAA/MAF/OPP procedure:

The OHP Statewide Processing Center (Branch 5503) will work a monthly report of

pregnant children under age 19 whose MAA/MAF eligibility is ending because there are

no dependent children on the case. The report will also list OPP children whose medical

is ending.

Example: Felicia is age 16 and receiving OPP. The DUE date on her CM

case is 08/09. In 07/09, 5503 will redetermine eligibility for

Felicia’s medical filing group.

17. Specific requirements; Healthy KidsConnect (HKC)

Overview

HKC provides health insurance to families through the Office of Private Health

Partnerships (OPHP). OPHP provides health insurance through HKC insurance carriers

or by helping the family pay for employer sponsored insurance (ESI).

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Families with income from 201 percent of the Federal Poverty Level (FPL) up to

301 percent FPL qualify for a subsidy payment from OPHP to help them pay for

the cost of the insurance. The subsidy is used to help pay the insurance premium

necessary to enroll the child with an HKC insurance carrier or to help pay the ESI

premium;

Families with income from 301 percent FPL and above may choose to enroll their

children with an HKC insurance carrier, but must pay for the entire premium

amount.

Even though families with income from 301 percent FPL and above do not qualify for

any DHS medical program, DHS is responsible for determining the family can be

referred to OPHP.

HKC families are automatically referred to OPHP when the HKC (KCA/KC3) coding is

entered on the family‟s CM system case.

After being determined eligible for HKC and the HKC coding is entered on the family‟s

CM system case, an automated referral is made to OPHP. OPHP works with the family to

enroll the child in one of the following categories:

(A) Healthy KidsConnect Employer Sponsored Insurance (ESI) subsidy for families

with income 201 percent to 301 percent FPL;

(B) Healthy KidsConnect subsidy for families with income 201 percent to 301

percent FPL; or

(C) Healthy KidsConnect full pay for families with income 301 percent and above.

Note: HKC families who do not pass the business $20,000 business entity income test

should be referred to OPHP as nonsubsidy (KC3) HKC clients.

HKC eligibility

To be eligible for HKC, a person must be under 19 years of age and must meet the alien

status requirement. There is no CAWEM coverage under HKC.

Income treatment and availability of income requirements used for determining HKC

eligibility are the same as used for CHIP.

Budgeting for HKC eligibility follows the same methodologies as those used for CHIP in

OAR 461-150-0055.

Determine eligibility using budget month income, including the $20,000 business

entity income test for principals of a business;

If not eligible using the budget month, the budget month can be floated.

FSML – 64D


Note: Float the budget month if the family indicates their income is decreasing and they

could qualify for OHP Plus or a higher subsidy level using the new budget month.

The countable income standard for HKC is at or above 201 percent of the federal poverty

limit. Families eligible for HKC with income 201 percent to 301 percent (KCS) are DHS

medical program clients. They qualify for a subsidy paid for with title XXI funds.

(Title XXI is also used to fund the CHIP program.)

Families eligible for HKC with income 301 percent and above (KC3 coding) or who do

not pass the $20,000 business entity income test are not DHS clients, but are referred to

OPHP anyway. Some families with income 301 percent and above choose to work with

OPHP. They choose to enroll with an HKC insurance carrier and pay the full insurance

premium.

In order to be eligible for HKC, the child must be a U.S. citizen or meet qualified alien

status.

If a child does not have citizenship documentation but is otherwise eligible for

HKC at 201 percent to 301 percent of the FPL, add the KCA coding to the CM

case. Also add the CIP coding and send a CMCITPD or other pend notice to the

family. Transfer the case to 5503 and mail/shuttle/UPS the application to 5503

using the HKC cover sheet;

Once the citizenship documentation has been provided. Update the child‟s Person

Alias/Update citizenship fields, remove (or have 5503 remove) the CIP/CIE

coding and narrate;

If it has been determined the family‟s income is 301 percent FPL and above, add

the KC3 coding to the CM case but do not add the CIP coding or pend the family

for citizenship documentation for the child. (I.e., do not pend when you are going

to deny the medical application anyway);

If the family‟s self-employment business does not pass the $20,000 business entity

income test, code as KC3 with HPK of $9999. The $9999 HPK income amount is

used as a way for OPHP to identify families who do not meet the $20,000 business

entity income test. A new case descriptor will be added to the CM system soon

that will replace the $9999 identifier. (Notification will be sent via transmittal

when the new case descriptor is ready.)

MORE INFORMATION ABOUT HKC CASE CODING IS BELOW IN THIS SAME

SECTION.

The eligibility period for HKC is a 12-month period. Once the child is approved as

eligible for HKC, the CM system refers the case to OPHP for a subsidized enrollment

with an HKC insurance carrier or for an ESI subsidy payment.

To be eligible for HKC, the child must not currently be covered by private major medical

health insurance or by any private major medical health insurance during the preceding

two months.

FSML – 64D


Note: The Kaiser Child Health and Kaiser Transitions insurance programs are not

considered private major medical. Neither program affects HKC (or CHIP)

eligibility.

After the private major medical has ended, there is a two-month waiting period before the

child can be enrolled by OPHP into HKC. However, if the child qualifies for a waiver of

the two-month waiting period, OPHP will ensure the private major medical has ended.

Do not delay referring families to OPHP if they are otherwise eligible for HKC and

qualify for a waiver of the two-month waiting period.

The two-month waiting period after the private major medical has ended is waived if:

a) The person has a condition that without treatment would be life-threatening or

cause permanent loss of function or disability (accept the client‟s statement);

b) The loss of health insurance was due to a change in employment (includes

children whose COBRA coverage has ended or whose parents choose to end

COBRA coverage);

c) The person‟s employer-sponsored health insurance premium was reimbursed by a

HIPP payment;

d) The person‟s private health insurance premium was reimbursed by a PHI

payment;

e) The person‟s private health insurance premium was subsidized by FHIAP or by

the Office of Private Health Partnerships (OPHP);

f) A member of the person‟s filing group was a victim of domestic violence.

If an HKC child is covered by private or employer-sponsored major medical and qualifies

for a waiver of the two-month waiting period:

Code the KCA or KC3 HKC referral on the CM system;

Send an email to OPHP at “OPHP INFO” in Outlook with the case number, case

name, name of the insurance company, phone number of the insurance company or

employer offering the insurance, names of child(ren) covered by the insurance. In

this instance, the private health insurance is not reported to HIG;

OPHP will work with the family and the insurance carriers so that the private

health insurance will be closed before the HKC benefits are issued.

SEE B.4 (MA-B.4) IN THIS CHAPTER FOR MORE INFORMATION ABOUT THE

EMAIL REFERRAL TO OPHP.

Example: John and Mary are applying for medical for their daughter Maria.

Maria has a health condition that without treatment could be

disabling. John and Mary have been paying for private third-party

FSML – 64D


insurance (TPL) for Maria but can no longer afford the premiums. The

family’s income is 252 percent of the federal poverty level (FPL) and

Maria could qualify for HKC after her insurance ends.

Since Maria has a health condition that qualifies her for a waiver of

the two-month uninsurance requirement, add the KCA coding to Maria

on the family’s CM case. Send an email to OPHP INFO letting OPHP

know that Maria qualifies for a waiver of the two-month wait. List the

case number, case name, Maria’s name and the name of the insurance

company (and the insurance company’s phone number, if known). Do

not report the private health insurance to HIG on the MSC 415H.

Example: Sara is applying for medical for her daughter Heather. Sara lost her

job, and has been paying for Heather’s insurance through COBRA.

The family’s income is 205 percent FPL and Sara cannot afford to

keep paying the COBRA health insurance premium.

COBRA coverage is due to a change in employment and qualifies

Heather for a waiver of the two-month waiting period. Refer to OPHP

by adding the KCA coding to the CM case. Send an email to OPHP

letting them know that Heather qualifies for a waiver of the two-month

wait. Include the case number, case name and list Heather as the

person qualifying for the two-month waiver. Include the name of the

health insurance company and phone number (if known). Do not

report the private health insurance to HIG on the MSC 415H.

Example: Jennifer is applying for medical for her son Franklin and daughter

Louise. Louise is included on her absent father’s insurance, but

Franklin has a different father and does not receive any insurance.

Jennifer just separated from Louise’s father because of domestic

violence. Jennifer explains that Louise’s father has been very upset

about having to pay for Louise’s insurance and continues to threaten

Jennifer.

Jennifer no longer wants to use the insurance for Louise and wants to

receive medical benefits for both Franklin and Louise. The family’s

income is at 220 percent FPL.

The two-month wait can be waived because of the domestic violence.

Send an email to OPHP letting them know Louise qualifies for a

waiver of the two-month wait. Include the case number, case name and

Louise’s name. Include the name of the health insurance company and

phone number (if known). Do not report the private health insurance

to HIG on the MSC 415H.

FSML – 64D


A child found eligible for HKC becomes ineligible if any of the following occur:

a) Upon reaching age 19: Children aging off of HKC at age 19 are not treated as

new applicants for OHP Standard. They do not need to be randomly selected from

the reservation list to qualify for OHP Standards as long as they establish a date

of request before their HKC ends. If eligible, they may transition into OHP

Standard effective the first of the month after the 10-day notice of reduction

period.

b) When the child becomes covered by private major medical (see

OAR 461-135-1100 for a definition of private major medical) and the insurance is

not under contract to OPHP.

c) Upon becoming a resident of another state.

d) When the family does not pay their share of the HKC insurance premium.

e) When OPHP determines the child no longer qualifies for enrollment through

OPHP.

f) When the department determines the child does not meet the requirements for

eligibility, including, but not limited to, failure to re-enroll before the end of the

eligibility period.

After determining eligibility

After making the eligibility decision, HKC cases must be transferred to Branch 5503:

Please transfer the KC3, KCA or KCE CM system case to the OHP Statewide

Processing Center (Branch 5503) online;

Shuttle, UPS or mail a copy of the application to 2850 NE Broadway, Salem OR

97303. Be sure to use the HKC cover sheet. The cover sheet is available on the

SSP medical tools website.

When to email OPHP

For HKC families with income from 201 percent of the federal poverty level (FPL)

to 301 percent FPL, determine if the child is eligible for a KCA referral to OPHP.

After coding the KCA/KCR referral on the CM system, send an email to

OPHP INFO in the following situations:

- When the KCA child is not receiving private major medical but it is

available;

- When the child who is otherwise eligible to be referred as a KCA child is

receiving private major medical but qualifies for a waiver of the two-month

waiting period.

FSML – 64D


When sending emails to OPHP INFO about Health Insurance, be sure to include the

following information:

Case number;

Case name;

Name and phone number of the insurance company, or, for employer sponsored

insurance, the name and phone number of the employer;

The names of child(ren) that are or could be covered by the insurance.

Note: The OPHP INFO email process replaces the MSC 415H process for HKC clients.

The MSC 415H is no longer faxed to OPHP. The MSC 415H is still completed

and sent to HIG for Medicaid clients.

Reporting changes

KCA and KCE families must report the following changes:

A change in availability of employer-sponsored health insurance;

A change in health care coverage;

A change in mailing address or residence;

A change in name;

A change in pregnancy status of any member of the filing group.

Redeterminations

Redetermine eligibility whenever an HKC subsidy (KCA or KCE coding) family reports

a pregnancy, when the certification period is due to expire, when a KCA/KCE child turns

age 19, when the family requests a new child be added to the KCA/KCE benefit group or

whenever there is a change reported that affects eligibility.

Adding a child to a KCA/KCE benefit group: When a KCA or KCE family requests a

child be added to the benefit group, redetermine eligibility for everyone in the family.

Review each child for CEC, CEM, EXT, MAA, MAF, OHP and OSIPM eligibility. If not

eligible for an OHP Plus program, consider KCA.

If as a result of the new redetermination to add the child, the new filing group‟s

countable HKC income increases so that the subsidy would be reduced, add the

child to the original HKC certification period using the original HPK income

amount. The new benefit group remains eligible at the same subsidy level for the

remainder of the original certification period;

If as a result of the new HKC redetermination to add the child, the HKC filing

group‟s countable HKC income decreases so that the subsidy would be increased,

FSML – 64D


add the child and establish a new 12-month certification period for every child in

the benefit group based on the new HPK income amount.

Converting from HKC subsidy (KCA or KCE coding) to another program: When a

KCA or KCE family is found eligible for another DHS medical program, convert the

children to the other program effective the first of the next month. Convert the adults to

the program effective the DOR.

SEE MA-B.11 FOR MORE INFORMATION ABOUT MEDICAL PROGRAM

EFFECTIVE DATES.

Special Branch 5503 procedures

Branch 5503:

Works a report of KCA/KCE children turning age 19;

Processes changes reported by the HKC subsidy client (KCA or KCE coding) to

OPHP. For example, when OPHP is notified that someone had moved in or out of

a KCA household or there is an address, phone number or other CM system update

is needed;

Redetermines eligibility for all HKC subsidy clients with cases in Branch 5503.

HKC CM system coding

Overview

For more information about the HKC CM system coding requirements, see the SSP

medical program website.

For all HKC referred children, regardless of the income or circumstances, do not use the

“VP” or “CP” CM case status to determine if the child is receiving medical benefits.

HKC referrals in “VP” or “CP” status do not mean the child is receiving any kind of

medical.

If the child has been referred to OPHP for HKC, the child will have a KCA or KC3 case

descriptor.

KCA children are eligible for DHS medical program benefits. Their family‟s

income is 201 percent to 301 percent. Once OPHP enrolls the child with an

insurance carrier or begins making ESI premium subsidy payments, the KCA case

descriptor will automatically be updated to KCE (HKC enrolled) and a medical

start date added or updated;

KC3 children are not eligible for DHS medical program benefits. They may

purchase health insurance, but must pay the full premium amount. DHS benefits

must be ended when completing the referral to OPHP. The CM case will remain in

“VP” status through the KC3 referral end date. KC3 children include children who

are not eligible for DHS medical program benefits because the financial group did

not pass the business entity $20,000 income test.

FSML – 64D


KCA (201 percent to 301 percent HKC referrals)

HKC clients eligible at the KCA level are DHS clients. Do not send them a denial or

closure notice when converting to HKC.

Enter the number in the need group (including unborns) in the #OHP field on the

UCMS screen;

Use the HPK income need/resource to list income amounts (instead of the HPI

need/resource).

Use a KCA case descriptor and need/resource item to identify each child who is HKC

eligible with income 201 percent to 301 percent.

Once the KCA coding is added, the CM system will automatically refer the KCA

child to OPHP. The CM case will display in VP status until the KC3 referral is

closed. OPHP has 45 days from the date of the referral to work with the family and

issue a subsidy payment;

Note: KCA children referred to OPHP may not have a medical start date on CMUP.

The only time a KCA child will have a medical start date on CMUP is if the child

is already receiving medical benefits through another program before the referral

is made.

For the KCA need/resource end date, use the month in which the 10-day notice

period ends after the 45-day period;

Example: A decision to refer to OPHP is made on April 15, 2010. Count

45 days from April 15 and add time for a 10-day notice. In this

example the KCA end date is 06/10.

If the KCA referred child is already receiving OHP Plus benefits, add the BED

code as needed to keep the benefits open until OPHP issues HKC benefits. Match

the BED end date to the KCA end date.

Use a KCR need/resource to identify each KCA referred child.

The KCR end date is 12 months from the referral date.

Example: The decision is made April 15, 2010, to refer a KCA child to

OPHP. The KCR end date is 04/2011.

Note: KCA-referred children are eligible for a DHS medical program. Do not send

them a denial notice. Also, the CM system will automatically send a referral

notice. If the child is BED coded, the computer will add the reduction information

to the referral notice. No 10-day notice of reduction is required.

Employer Sponsored Insurance coding:

If the family has employer sponsored insurance available for the KCA child but the child

is not receiving the insurance:

FSML – 64D


Add an ESP need/resource item with a continuous date (ESP C) for each child

with the available coverage. (Consider the insurance available even if it is not the

employer‟s open enrollment period).

KC3 (301 percent and above HKC referrals):

Enter the number in the need group (including unborns) in the #OHP field on the

UCMS screen;

Use the HPK income need/resource to list income amounts (instead of the HPI

need/resource). If the family is eligible for KC3 because the family is self-

employed and the business entity income is $20,000 or higher, enter nines (9999)

as the HPK income amount.

Use a KC3 case descriptor and need/resource item to identify each child who is HKC

eligible with income 301 percent and above.

HKC children with family income at or above 301 percent are not DHS medical program

clients. Families with children receiving DHS medical program benefits must be sent the

CMCNSUB closure notice and a DHS 462A notice. Families with children who are not

currently receiving DHS medical program benefits must be sent a CMDNSUB denial

notice and a DHS 462A notice.

Use a KC3 case descriptor and need/resource item for each child needing referral

at 301 percent or above;

For the KC3 need/resource end date, use the month after the referral was made.

The CM case will display in VP status until the KC3 referral is closed;

If the children are currently receiving DHS medical benefits, enter a COMPUTE

action and end benefits the end of the month after the 10-day notice (and

DHS 462A) is sent. You might need to wait until after the CM system compute

deadline before adding the KC3 referral.

Note: KC3-referred clients are not eligible for any DHS medical program. Do not

forget to send them a closure or denial notice with the DHS 462A notice. No

notice is required for the KC3-referred children. The CM system will

automatically send a referral notice.

Filing Group; HKC, OHP: 461-110-0400

Periodic Redeterminations; Not EA, ERDC, EXT, OHP, REF, REFM, SNAP or TA-DVS: 461-115-0430

Certification Period; HKC, OHP: 461-115-0530

Required Verification; BCCM, EXT, HKC, MAA, MAF, OHP, SAC: 461-115-0705


Specific Requirements; Healthy KidsConnect (HKC): 461-135-1101

Income Standard; HKC, OHP, REFM: 461-155-0225

Concurrent and Duplicate Program Benefits: 461-165-0030

Changes That Must be Reported: 461-170-0011

Notice Situations; General Information: 461-175-0200

Effective Dates: Initial Month Medical Benefits: 461-180-0090

FSML – 64D

February 29, 2011 Child Support Program TOC Page - 1

Child Support Program

Table of Contents

A. Child Support Program (CSP); Intent and Overview 1. Program intent

2. Program overview

B. Assignment of Support Rights 1. Support assignment requirement

2. Who must assign their rights

3. Amount of support assigned

4. Assigning and pursuing support for TANF and Medical - general considerations for

branch office staff

5. Procedure for assigning support

6. Role of the Division of Child Support (DCS) when support is assigned

C. Requirement to Cooperate, Noncooperation Penalties and Good Cause 1. Requirement to cooperate with the Department of Human Services (DHS) and the

Division of Child Support (DCS) in obtaining support payments, health care

coverage through an absent parent and cash medical support

2. Evidence of cooperation

3. Good cause for failure to cooperate; child support, health care coverage through an

absent parent and cash medical support

4. Good cause; branch office responsibilities

5. Evidence of good cause; child support, health care coverage through an absent

parent and cash medical support

6. Encouraging cooperation

7. Determining noncooperation

8. Penalties for noncooperation; child support

9. Penalties for noncooperation; health care coverage through an absent parent and

cash medical support

10. Ending support penalties when client cooperates

11. Pregnant women – special considerations

12. Special considerations; support

13. Coordination on cases excused from the requirement to pursue child support, health

care coverage through an absent parent or cash medical support

D. Reporting Noncustodial Parents to the Division of Child Support (DCS) 1. Noncustodial parent questions for intake and redetermination

2. Explaining teferral process to clients; branch office responsibilities

3. Cases to be reported to DCS – TANF and Medicaid

4. Process for reporting noncustodial parents to DCS – TANF and Medicaid

5. Process for reporting noncustodial parents to DCS – Pre-TANF, Child Care and

Supplemental Nutrition Assistance programs

6. DCS actions and responsibilities (all programs)

7. Services provided by DCS (all programs)

FSML – 64D

Page - 2 Child Support Program TOC February 29, 2011

8. Notifying DCS of new or additional information (all programs)

9. Deceased noncustodial parent or alleged father – special considerations (all

programs)

E. Linking of TANF and Medicaid Case and Related Division of Child

Support (DCS) Case on CSEAS 1. TANF/Medicaid cases with existing CSEAS case

2. TANF/Medicaid cases with no existing CSEAS case

3. When the CM system information does not create or link to a CSEAS case

F. Disbursement of Child Support and Cash Medical Support Payments 1. Child support disbursement on active TANF/Medicaid cases; Division of Child

Support (DCS) responsibilities

2. Child support disbursement on active TANF cases; branch office responsibilities

3. Child support disbursement on closed TANF cases

4. Child support distribution guide

G. Self-Sufficiency Workers Access to Child Support Program (CSP)

Information 1. Brief overview of requirements for Self-Sufficiency Program staff who access

Child Support Program information

2. Brief overview of access to and confidentiality of CSP information

3. CSP mainframe screens SSP workers may access

4. CSP website

5. Access to child support information when there is a safety option

6. Printing CSP screens

7. Conflict of interest - Child Support Program

H. Child Support Pass-Through and Disregard 1. Pass-through

2. TANF and SSP Medical Program recipients

FSML – 64D Child Support Program C –

February 29, 2012 Requirement to Cooperate, Noncooperation Penalties and Good Cause C - 1

C. Requirement to Cooperate, Noncooperation Penalties and Good Cause

1. Requirement to cooperate with the Department of Human Services (DHS) and the

Division of Child Support (DCS) in obtaining support payments, health care

coverage through an absent parent and cash medical support

Child support for TANF applicants. To be eligible for TANF, caretaker relatives must

cooperate (unless good cause exists – see items 3 through 6, below) with DHS and with

DCS in establishing paternity and obtaining support payments for all children in the

benefit group. (This does not apply to applicants who may be eligible for cash benefits

based on the unemployment or underemployment of the primary wage earner.)

Child support for TANF recipients. TANF recipients must also cooperate (unless good

cause exists, see items 3 through 6 below) with DHS and DCS in establishing paternity

and obtaining support payments for all children in the benefit group. (This does not apply

to TANF recipients in the SFPSS or Post-TANF programs or those who are eligible for

cash benefits based on the unemployment or underemployment of the primary wage

earner.) When a TANF recipient who is required to cooperate does not cooperate (and

does not have good cause for the noncooperation), the recipient will be subject to the

penalties in item 8 below (CS-C.8).

Client Required To Help Department Obtain Support From Noncustodial Parent; TANF: 461-120-0340(1)

Cash medical support. To be eligible for all programs except ERDC, SNAP, OHP-CHP

and REFM, Medicaid recipients must cooperate (unless good cause exists, see items 3

through 6 below) with DHS and DCS in establishing paternity and obtaining cash

medical support for all children in the benefit group.

Medicaid applicants at initial application and Medicaid recipients at

redetermination need only sign the application. Do not require completion of a

paternity affidavit as a condition of Medicaid eligibility at initial application or at

redetermination.

Health care coverage through an absent parent. To be eligible for all programs except

ERDC, SNAP, OHP-CHP and REFM, the client must cooperate, unless good cause exists

(see items 3 through 6, below), in establishing paternity and obtaining health care

coverage through an absent parent.

For TANF, Medicaid and REF, the caretaker relative must cooperate for the

dependent children in the benefit group;

Medicaid applicants at initial application and Medicaid recipients at



redetermination;

Child Support Program C – FSML – 64D

C - 2 Requirement to Cooperate, Noncooperation Penalties and Good Cause February 29, 2012

For EA and EA medical, clients are required to cooperate only if health care

coverage through a noncustodial parent can be made available in time to meet the

emergent medical need.

Client Required To Help Department Obtain Support From Noncustodial Parent; TANF: 461-120-0340 Clients Required to Obtain Health Care Coverage and Cash Medical Support; CEM. EXT, GAM, MAA, MAF, OHP

(except OHP-CHP), OSIPM, SAC: 461-120-0345

2. Evidence of cooperation

Cooperation with child support, health care coverage through an absent parent and cash

medical support exists when the client provides information that DHS and DCS need or

request to establish paternity, or to establish, modify or enforce a child support order, for

the child(ren) in the TANF or Medicaid benefit group.

Note: Medicaid applicants at initial application and Medicaid recipients at



redetermination.

The client demonstrates cooperation by doing all of the following:

Supplying sufficient information to enable DCS to proceed with appropriate

action. Sufficient information includes, but is not limited to, as many of the

following elements of information as the client knows (or can reasonably be

expected to find out) regarding any and all noncustodial parents of such dependent

children:

- Full legal name and nicknames;

- Social Security number;

- Current or last known address;

- Current or last known employer, including name and address;

- If a student, current or last known school;

- Criminal record, including where and when incarcerated;

- Date of birth, or age;

- Race;

- Date and place of each child’s conception (if paternity is not established);

- Any known group or organizational affiliations of the noncustodial parent;

- Names and addresses of close friends or relatives.



Any other information DHS or DCS may request that would help locate or identify

a noncustodial parent of a child in the benefit group;

Supplying documentation or explanation of efforts to get information requested by

DHS or DCS (if unable to provide any necessary information listed above);

Keeping appointments with DHS and DCS related to establishing paternity;

Returning telephone calls or responding to correspondence when requested by

DHS or DCS;

Otherwise demonstrating a good faith effort to obtain necessary information and to

locate and identify each alleged parent or noncustodial parent, establish legal

paternity, establish and enforce a support order, and obtain support payments, to

the full extent possible allowing for the client’s individual circumstances.

Client Required To Help Department Obtain Support From Noncustodial Parent; TANF: 461-120-0340

3. Good cause for failure to cooperate; child support, health care coverage through an

absent parent and cash medical support

A client may claim good cause for not cooperating with DHS and/or DCS to establish

paternity or to collect child support, health care coverage through an absent parent and

cash medical support.

Note: Caretaker relatives of OHP-CHP or REFM children are not required to

cooperate with DCS for cash child support, health care coverage through an

absent parent or cash medical support.

Good cause for failure to cooperate with support, health care coverage through an

absent parent and cash medical support requirements exists when any of the

following are true:

- Cooperation is reasonably anticipated to result in emotional or physical

harm to the child(ren) in the family;

- Cooperation is reasonably anticipated to result in emotional or physical

harm to the client or to other caretaker relatives of the child(ren) involved;

- One of the following circumstances exists and DHS believes that

continuing efforts to obtain support would be detrimental to the child(ren):

(a) The child was conceived as a result of incest or rape;

(b) Legal proceedings for adoption are under way before a court;



(c) The parent is being helped by a public or licensed private social

agency to resolve the issue of whether to release the child for

adoption. This good cause reason is limited to three months.

If good cause is found, DCS will take no action to establish paternity or child

support or to enforce child support;

When DCS determines that a client is not cooperating and there is an open TANF

or Medicaid case, DCS will tell the DHS branch office. The DHS branch office is

responsible for determining if the client had good cause or if noncooperation

penalties shall be applied.

On a closed TANF or former ADC case where past-due support remains assigned

to Oregon or to another state and the former client is not cooperating, DCS may

determine if the former client has good cause for not cooperating. DCS will make

this determination pursuant to all DCS rules and policy regarding good cause. If

DCS determines that the former client has good cause for not cooperating, DCS

will not pursue collection of assigned arrears if doing so could lead to harm to the

former client or to the children. If the former client does not have good cause for

not cooperating, DCS will continue to pursue assigned arrears (but there will be no

reduction of TANF benefits, since the former client is no longer receiving TANF);

If good cause is found on an open TANF or Medicaid case, DHS should:

1) Code the case with good cause. Good cause coding should be

added to the absent parent field on PCMS or CMUP. While A, B,

and M are all valid good cause codes and will stop DCS from

pursuing paternity and/or support from the absent parent on which

the coding was added, please enter B. (Entering A, C or M may

cause confusion for partner staff.)

2) Notify the appropriate DCS worker that the case has been coded

good cause by phone or email.

The need for continued good cause coding should be reviewed at each

redetermination;

When DCS is told by an obligee who is applying for or getting TANF or medical

assistance that the pursuit of paternity and/or support may cause a safety concern

for the obligee or the obligee’s child(ren) and the TANF or medical case has not

already been coded with good cause for noncooperation with support, the

following steps shall be followed:

1. The DCS worker who learns that the obligee has a concern will either:

Send an email to the local DHS worker (if DCS is able to identify the

worker) and to the appropriate DHS SSP Child Support Point Person; or



Send an email to the appropriate DHS worker, if DHS and DCS local

management have agreed to a local process different from that described in

the paragraph above.

2. The email sent by DCS will include the name of the obligor, the name of

obligee, the name(s) of the children and any information the DCS worker

has about the safety concern.

3. The same day that DHS receives the email from DCS, the TANF or

medical-only case will be coded by DHS with good cause for

noncooperation with support, and the local DHS worker will narrate that

good cause was added at the request of DCS.

4. The local DHS worker will proceed with determining whether there is good

cause for noncooperation with support, or whether claim of risk may be an

option to enable pursuit of paternity and support safely.

5. If the local DHS worker determines that the case should be coded with good

cause for noncooperation with support, the worker will leave the case coded

good cause. If the DHS worker determines that the case should not be coded

with good cause, the worker will remove the good cause coding. The worker

will narrate on TRACS whether the determination was to leave or remove

the good cause coding. The worker will also email the DCS worker to let the

DCS worker know whether good cause coding has been removed.

Clients Excused for Good Cause from Compliance with OAR 461-120-0340 and -0345: 461-120-0350

4. Good cause; branch office responsibilities

The DHS branch office is responsible for informing clients of their right to claim good

cause, both when the client applies for assistance and at each redetermination of

eligibility. When the client applies for TANF, Medicaid, or OSIPM, and one or both

parents of any child in the benefit group are absent from the benefit group, the branch

office will:

Explain to the client that unless the client has good cause for not cooperating:

Cooperation in efforts to obtain child support payments, health care coverage

through an absent parent, and cash medical support is a condition of eligibility for

TANF;

Cooperation in efforts to obtain health care coverage through an absent parent and

cash medical support is a condition of eligibility for Medicaid, except for medical

benefits for a pregnant female;



Ask the client to read and sign a Cooperating with Child Support Enforcement

form (DHS 428A), except for medical benefits for a pregnant female who chooses

not to cooperate with DCS;

Note: For OHP, this requirement is met by having the client sign the “Oregon Health

Plan Rights and Responsibilities” Application for Oregon Health Plan and

Healthy Kids (OHP 7210).

Explain to the client the purpose of the referral to DCS, and encourage the client to

cooperate with DHS and DCS for the benefit of the children.

Confidentiality of client’s address. Explain to clients that under state law, certain

information that is confidential under DHS rules could be released during legal

proceedings. For example, the client’s home address could be revealed to the

noncustodial parent if the address appears in the noncustodial parent’s copy of a support

order.

Contact address. If the client does not want their address revealed, determine if there is

good cause for not pursuing support per OAR 461-120-0350. If the client does not want

to claim good cause but does not want their address known to the noncustodial parent, the

client may ask DCS to use a contact address. The contact address must be in Oregon and

will be used for child support purposes only. The contact address will only be used once

DCS adds the address to the DCS computer system. If the contact address was not

requested at the time the child support case was created, the home address may have

already been included on child support paperwork sent to the other party on the case or to

court.

If DHS knows the client would like to use a contact address, DHS should notify DCS of

this by calling or emailing the appropriate DCS worker.

Cautions:

Due to the nature of the linkage between the DHS (CM) computer system and

DCS’s Child Support Enforcement Automated System (CSEAS), the client’s

address on CSEAS will show the same address as on CMS. The only place the

contact address will appear on the CSEAS system is on a separate screen in

CSEAS, accessible to DCS staff;

If a contact address has been in place for six months, DCS will attempt to contact

the client to ask if the address of record is still valid prior to initiating a new legal

action. The contact address will stay in effect until retracted by the client;

It is very important that clients be alert to picking up mail at their contact address.

If clients do not pick up their DCS mail, they may lose an opportunity to establish

paternity or to help determine a proper monthly support or arrearage amount. If the

client does not respond to a mailed notice, DHS could also determine that they

have failed to cooperate with the support requirement;



Even if the client claims good cause per OAR 461-120-0350, the client may want

to designate a contact address (for mailing support information only). This is

because support enforcement agencies are required by law to provide services

(including establishment of paternity) not only to custodial parents but also to

noncustodial parents – including self-alleged fathers – who apply for services. If

the only address on the case is the DHS address, this is the address that will be on

the legal documents during any subsequent proceedings. If the client claiming

good cause wants to use another address, proceed as above;

DCS cannot guarantee that the client’s actual home address will not be revealed

during enforcement or court proceedings. Designating a contact address simply

decreases the likelihood of this occurring, and enables DCS to proceed on what

could otherwise be a good cause case.

Nondisclosure of information based on a Claim of Risk. Also tell the client that DCS has

further protections available for clients who would cooperate if their personal identifying

information will not be revealed. This is known as “claim of risk.”

Advise the client that, before initiating any court proceedings, DCS will notify the client

in writing that:

DCS must include the client’s personal identifying information in any motions,

pleadings, petitions, orders, or other legal documents filed with the court; and

To avoid having their personal identifying information revealed in court

documents, the client may file a “nondisclosure of information based on a claim of

risk” request with DCS. To file a “nondisclosure of information based on a claim

of risk” request, the client must provide a contact address.

If the client files a claim of risk request in response to receiving notification from DCS of

a forthcoming legal action, DCS will reveal the client’s personal identifying information

to the court only in the form of sealed documents submitted to the court. These

documents do not become “Public Record.”

The client can contact DCS to request claim of risk. However, if DHS knows the

client would like to request claim of risk, DHS should:

1) Code the case with good cause until DCS has coded the child

support case as “claim of risk.” (Because DHS cannot see the CSP

mainframe screens when a case is coded with claim of risk, the

DCS worker must let DHS know when the claim of risk coding has

been added to the child support case. Once DCS has added the

claim of risk coding, the DHS worker should remove the good

cause coding from the DHS case.).

2) Notify the appropriate DCS worker of the “claim of risk” request

by phone or email.

3) Have the client fill out the Claim of Risk (DHS 8660B) and fax to

the appropriate DCS office.



Case Management Opportunity

If the client claims “good cause” due to a domestic violence situation, discuss with the

client any crisis intervention or domestic violence counseling services that may be locally

available.

Confidentiality -- Finding of Risk and Order for Nondisclosure of Information: 137-055-1160

Clients Excused for Good Cause from Compliance with OAR 461-120-0340 and -0345: 461-120-0350

5. Evidence of good cause; child support, health care coverage through an absent

parent and cash medical support

Evidence of good cause for noncooperation includes, but is not limited to:

A client’s statement, for clients who believe that pursuing support will put their

safety or the safety of their child(ren) at risk;

Birth, medical or law enforcement records as evidence of incest or rape;

Court records, other legal records or written statements from a public or licensed

private social agency or an attorney regarding possible or pending adoption of the

child(ren) in question;

Sworn statements from individuals, other than the client, with knowledge of the

circumstances that provide the basis of the client’s claim of good cause.

6. Encouraging cooperation

To encourage clients to cooperate, emphasize these points:

Support from the noncustodial parent could help lessen the child’s feelings of

abandonment or desertion;

Establishing paternity can entitle the child to receive SSB or veteran’s benefits on

the alleged father’s account, should the alleged father die or become entitled to

disability benefits;

Support payments can help families pay for living expenses and become self-

sufficient, especially after the family is no longer eligible for TANF or Medicaid;

If the client is interested in good cause, also inform the client that there may still

be options for safely collecting support, such as by establishing a contact address

and/or filing a “nondisclosure of information” request – see item 4, (CS-C.4),

above. Give the client a copy of the Client Safety Packet on Good Cause Version A

(DHS 8660) to aid in the discussion of options for safely collecting support.



7. Determining noncooperation

DHS or DCS may determine if a client is not cooperating. DCS must advise DHS

whenever they determine noncooperation. DHS shall then:

If the client claims good cause under OAR 461-120-0350 for not cooperating, ask

the client for further information and work with the client to determine if the client

qualifies for a good cause exception;

If the client does not claim good cause under OAR 461-120-0350 for not

cooperating, or if the client claims good cause and DHS determines that the client

does not have good cause, apply penalties per items 9 or 10 (CS-C.9 OR CS-C.10),

below.

8. Penalties for noncooperation; child support

The penalties for failure to cooperate with support requirements are:

For benefit groups not currently receiving TANF, where the failure to cooperate

occurs during the process of applying or reapplying for TANF, total ineligibility

for the filing group;

For benefit groups receiving TANF when failure to cooperate is determined, the

net monthly TANF benefit amount, after income deductions and reductions for

JOBS noncooperation are applied (where applicable), shall be reduced by the

following percentages:

- 25 percent for the month following the month in which failure to cooperate

is determined;

- 50 percent for the second month following the month in which failure to

cooperate is determined;

- 75 percent for the third month following the month in which failure to

cooperate is determined;

- 100 percent (total ineligibility for the benefit group) for the fourth month

following the month in which failure to cooperate is determined, and all

subsequent months in which failure to cooperate continues.

Note: Before applying the 100 percent level of penalty, use the existing grant

termination staffing process to assess the family’s situation. When appropriate,

involve community partners in the family assessment.

Note: There is no requirement to cooperate with child support (and no penalties for

noncooperation), for clients in the SFPSS or Post-TANF programs.



Once a penalty has ended (see Section C.10 (CS-C.10) of this chapter), any

subsequent penalties for noncooperation with DCS will start at the first level (25

percent, per above) for clients who were previously disqualified or penalized for

noncooperation but later had full benefits restored;

For TANF-related medical, no eligibility for the person who fails to cooperate;

For SNAP, when a TANF payment is reduced or ends due to DCS noncooperation,

count the amount the TANF benefit payment would have been if not reduced for

noncooperation, for the duration of the penalty.


9. Penalties for noncooperation; health care coverage through an absent parent and

cash medical support

The penalty for failure to cooperate with health care coverage through an absent parent or

cash medical support is:

For all programs except OHP, removing the needs of the person who refuses to

cooperate;

For OHP, removing the person who refuses to cooperate from the benefit group;

Additionally, when calculating SNAP benefits, if a cash payment is reduced or

ends due to this penalty, count the amount the cash payment would be if the

penalty had not been imposed for the duration of the penalty.

Client Required To Help Department Obtain Support From Noncustodial Parent; TANF: 461-120-0340(4) Clients Required to Obtain Health Care Coverage and Cash Medical Support; CEM. EXT, GAM, MAA, MAF, OHP

(except OHP-CHP), OSIPM, SAC: 461-120-0345(3)

10. Ending support penalties when client cooperates

End the support noncooperation penalties when the client cooperates by completing the

necessary forms, providing requested information, scheduling an appointment with DCS

or taking whatever other actions are required to indicate cooperation as listed above.


Clients Required to Obtain Health Care Coverage and Cash Medical Support; CEM, EXT, GAM, MAA, MAF, OHP


11. Pregnant women – special considerations

For EXT, GA, MAA, MAF, OHP, OSIP and REF, there is no penalty for pregnant

clients who fail to cooperate;



A pregnant woman may be eligible for Medicaid even if she does not pursue

support.

Clients Required to Obtain Health Care Coverage and Cash Medical Support; CEM. EXT, GAM, MAA, MAF, OHP


12. Special considerations; support

Explain to clients that under state law, certain information that is confidential

under DHS rules, such as the client’s address, may be released during legal

proceedings. Refer to Section D (CS-D) for more information on DCS referrals;

If any clients who are not required to pursue child support want help getting the

support, refer them to their local county district attorney (or to the DCS branch

office for those counties where DCS provides such services in lieu of the district

attorney).

13. Coordination on cases excused from the requirement to pursue child support, health

care coverage through an absent parent or cash medical support

General

Self-Sufficiency and Child Welfare agree to work together, and with other impacted

agencies, such as the Division of Child Support (DCS) and the Oregon Youth Authority,

on cases that have been granted good cause or a permanent exemption and that transition

from one program to another.

TANF and Medicaid assistance – Clients receiving TANF or Medicaid assistance

are excused from the requirement to pursue child support (OAR 461-120-0340(1))

and the requirement to pursue medical coverage (OAR 461-120-0345(1)(a)) if:

- Helping the Child Support Program could result in emotional or physical

harm to the child or to the caretaker relative;

- The child was conceived as a result of incest or rape and efforts to obtain

support would be detrimental to the child; or

- The parent is working with a public or private social agency to help decide

whether to release the child for adoption.

Child Welfare – Clients receiving services from Child Welfare are excused from

the requirement to pursue child support if:

- The biological mother conceived the child as a result of incest or rape and

efforts to obtain support would be detrimental to the child;



- The biological parents have signed a relinquishment of parental rights or

have been terminated of parental rights by a court action;

- A child who has been adopted through the State of Oregon comes back into

state care because of emotional or physical treatment needs; or

- The Assistant Director of Children, Adults and Families, or their designee,

determines that pursuit of child support is not in the best interest of the

child.

Coordination on cases

In order to support the transition and coordination of cases that have been excused from

the requirement to pursue child support or medical support because of good cause or a

permanent exemption, Child Welfare and Self-Sufficiency agree that:

Whichever program makes a determination of good cause or permanent exemption

“owns” the determination until or unless that program is no longer providing

services. This means only the program that made the determination of good cause

or permanent exemption may change the determination until or unless that

program is no longer providing services;

A determination of good cause or permanent exemption applies to all open cases

that involve the same obligee and obligor without regard to which program made

the determination of good cause or permanent exemption and whether the children

are receiving multiple services. This means, for example, that if a Self-Sufficiency

client were excused from pursuing child support for good cause, that client would

also be granted a permanent exemption for not pursuing child support if the client

subsequently opens a case with Child Welfare;

Once a case closes, or services are no longer provided by a program, that program

may not change a determination of good cause or permanent exemption that it

made prior to the case closing;

When there has been a determination of good cause or permanent exemption and

services are closed with one program, such as Self-Sufficiency, and opened with

another program, such as Child Welfare, the new program providing services will

follow steps (1) through (3) set out below.

1. The new program providing services will determine whether good

cause or permanent exemption is still appropriate by contacting the

person who originally claimed good cause or permanent

exemption.

2.(a) If it is determined after contact with the person who originally

claimed good cause or permanent exemption that there are still

safety or other issues that continue to make good cause or

permanent exemption appropriate, the new program providing



services will code the newly-opened case with good cause or

permanent exemption.

2. (b) If it is determined after contact with the person who originally

claimed good cause or permanent exemption that there are no

longer safety or other issues, the new program providing services

will not code the newly-opened case with good cause or permanent

exemption and will notify DCS that good cause or permanent

exemption coding should be removed from the Child Support case

and pursuit of child or medical support resumed.

3. If, pursuant to (2)(b) above, it is determined after contact with the

person who originally claimed good cause or permanent exemption

that there are no longer safety or other issues, the new program

providing services will give notice to the person who originally

claimed good cause or permanent exemption. Notice to the person

who originally claimed good cause or permanent exemption must

be documented by the program providing notification.

Coordination with partner agencies

When the Oregon Youth Authority has excused a case from the requirement to pursue

child support or medical support, Child Welfare and Self-Sufficiency shall coordinate

with the Oregon Youth Authority in the same manner as if Child Welfare or

Self-Sufficiency had excused the client from pursuit of child support because of good

cause or a permanent exemption.

When a case has been excused from the requirement to pursue child support or medical

support, regardless of which program has made the determination of good cause or

permanent exemption, Child Welfare and Self-Sufficiency will work with the Division of

Child Support to support transition and coordination of the case.



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FSML – 64D Child Support Program G –

February 29, 2012 Self-Sufficiency Workers Access to Child Support Program Information G - 1

G. Self-Sufficiency Workers Access to Child Support Program (CSP)

Information

This section contains a brief overview of the requirements for Self-Sufficiency Program

(SSP) staff who access CSP information. It also contains a brief overview of the laws and

rules on confidentiality and the CSP screens SSP workers have access to. However, in

addition to the brief overviews contained in this section, SSP workers who access CSP

information are required to read the document titled “Accessing Child Support Program

Information,” which is found at

http://www.dhs.state.or.us/policy/selfsufficiency/publications/screen-access-trng.pdf.

1. Brief overview of requirements for Self-Sufficiency Program staff who access Child

Support Program information

Self-Sufficiency Program (SSP) workers who administer title IV-A (TANF), title XIX

(Medicaid), SNAP and ERDC have access to CSP information via computer screen or via

contact with CSP employees.

SSP workers who access CSP information must read and follow ORS 25.260

(Confidentiality of Records; Rules), OAR 137-055-1140 (Confidentiality of Records in

the Child Support Program), OAR 137-055-1145 (Access to Child Support Records) and

the Department of Human Services (DHS) Conflict of Interest policy and procedures.

Staff must also be able to report a conflict of interest with a CSP case to their supervisor

using form Notice of Conflict of Interest with a Child Support Program Case (DHS 429)

(available at http://dhsforms.hr.state.or.us/Forms/Served/DE0429.pdf) .

2. Brief overview of access to and confidentiality of CSP information

Access to CSP information is based on what access is allowed under state and federal law

and rule. Whether a DHS worker has access to CSP information depends on what

program the worker is administering and the purpose of the access.

Confidentiality of CSP information is also based on federal and state law and rule.

In brief, the laws, rules and policies that govern access to CSP information and

confidentiality of CSP information state that:

Workers administering title IV-A (TANF), title XIX (Medicaid), SNAP and

ERDC may access CSP information including obligor name, SSN, date of birth,

address and phone number; obligee name, SSN, date of birth and address;

obligor’s employer’s name and address; child’s name, SSN and date of birth;

whether health coverage is ordered and, if so, whether it is provided;

The information in the paragraph above may be accessed either via CSP screens or

via contact with DCS;

Child Support Program G – FSML – 64D

G - 2 Self-Sufficiency Workers Access to Child Support Program Information February 29, 2012

There are penalties for violation of the laws and rules related to confidentiality of

and access to CSP information;

Workers with access to CSP computer or other records available to them as

employees of DHS are prohibited from accessing records that pertain to their own

CSP case. Workers are also prohibited from accessing any CSP case that, if they

were to access the case, may receive, or have the appearance of receiving, biased

treatment. This is generally referred to as “conflict of interest”;

SEE ITEM 6 BELOW FOR MORE INFORMATION ON CONFLICT OF INTEREST

(CS-G.6).

When possible inappropriate use of CSP information is identified, the CSP

Director, after consulting with the employee’s agency, will determine whether the

use or disclosure likely occurred and the employee’s access to CSP records will

either be revoked permanently or temporarily, if a determination by the CSP

Director is pending. Revocation of access is in addition to any other penalty for

use or disclosure of confidential information that is in violation of law or policy.

ORS 25.260

Access to Child Support Records: 137-055-1145

OAR 137-055-1149

3. CSP mainframe screens SSP workers may access

Go to http://www.dhs.state.or.us/caf/ss/tanf/docs/CSP_screens_quick_ref.pdf for tips on

navigating each of the screens listed below.

SESR

Displays CSP employee information including contact information.

SJ7F

Displays CSP case information about obligor, obligee, beneficiaries, payments,

claim of risk or good cause, etc.

SMCL

Displays narrative lines for the CSP case.

SMIC

Displays additional beneficiary information.

SMR1

Displays detail information regarding a particular billing segment.

SMU1

Displays CSP case information about obligor, obligee, beneficiaries, legal actions

on the case, etc.



SMUA

Displays the amount of assistance paid for the current month and the amount paid

since the case was open.

SMUX

Displays CSP cases by name, SSN or TANF case number.

SOPA

Displays obligee, obligor and employer information.

SOYA

Displays Oregon Youth Authority information pertaining to a CSP beneficiary.

WPAY

Displays history of payments received on a child support case from 1982 to the

current month. There may be some exceptions.

Note: An SSP worker can also contact a DCS worker to get child support case and

payment information. An Authorization for Release of Information (MSC 2099) is

not needed for SSP to get information from the CSP mainframe screens or from a

DCS worker.

REMINDER: SSP workers who access CSP information are required to read the

document titled “Accessing Child Support Program Information,” which

may be found at

http://www.dhs.state.or.us/policy/selfsufficiency/publications/screen-

access-trng.pdf.

4. CSP website

The Child Support Program website at

http://www.oregonchildsupport.gov/parents/index.shtml contains child support case and

payment information. Before a DHS worker may access the CSP website for client

information, the client must complete and sign an Authorization for Use and Disclosure

of Information (MSC 2099) specifically authorizing this access.

Note: A client cannot be required to complete an MSC 2099 authorizing this access.

5. Access to child support information when there is a safety option

SSP workers cannot access any CSP mainframe screen for a child support case coded

claim of risk (COR), good cause for noncooperation with support (GC) or Address

Confidentiality Program (ACP).

To get information when a child support case is coded COR, GC or ACP SSP workers

can do the following:



When a case is coded COR or ACP, have the client complete and sign the

MSC 2099 authorizing the SSP worker to access the CSP website for child support

case and payment information. (Information on cases coded GC is not available on

the CSP website.)

Contact the DCS worker, branch office or appropriate DCS point person for child

support case and payment information.

Note: DCS cannot give SSP information about the person on the child support

case who requested the COR, GC or ACP. However, DCS can give SSP

information, including payment information, when it is not about the

person on the child support case who requested COR, GC or ACP.

Remember: SSP does not need to have an authorization for release of information

completed to get information about a client from a DCS worker or from the CSP

mainframe screens. An authorization is needed only when SSP is accessing the

CSP website for client information.

Ask the client to provide the information that is needed.

6. Printing CSP screens

SSP staff may not print CSP screens. If an SSP worker needs to document information

from CSP screens, the worker should narrate the information in TRACS.

Exception: The only exception to the paragraph above is that Hearings

Representatives may print CSP screens for use in a hearing when:

The purpose of the hearing is related to the administration of

title IV-A (TANF program), title XIX (Medical programs) or

SNAP; AND

All information related to the other party and beneficiary

including names, addresses, employer, birth dates, Social

Security numbers, etc., has been redacted (blacked out) before

the printout is submitted for the hearing.

7. Conflict of interest - Child Support Program

General

DHS employees are required to notify their supervisor when the individual employee has

a potential conflict of interest with a Child Support Program (CSP) case. Notification

must be in writing using the Notice of Conflict of Interest with a Child Support Program

Case (DHS 429).



“Conflict of interest” means that a CSP case may receive, or have the appearance of

receiving, biased treatment if the employee has access to or continues to have access to

the case.

Accessing CSP cases involving friends, relatives or acquaintances

A conflict of interest arises when an employee has been working on a case, or is assigned

a case, and the case is either a CSP case or a case with a linkage to a CSP case that

involves a friend, relative, acquaintance, etc.

The DHS employee must report this to their manager in writing using the DHS 429.

It is a violation of policy for a DHS employee to knowingly access the CSP case file of a

friend, relative or acquaintance using CSP computer screens or other records available to

them as DHS employees.

Accessing own CSP case

DHS employees shall not access their own CSP case file using CSP computer screens or

other records available to them as DHS employees.

Any DHS employee who has their own CSP case and who has access to CSP screens

must notify their supervisor of their case using the DHS 429.

This requirement applies for open CSP cases that are in the Oregon CSP system;

This requirement also applies for closed cases that are in the Oregon CSP system

except when the child(ren) on the case is over 18 years of age, no arrears are owed

and the case was closed more than five years from the date the client is reporting

the conflict of interest.

In some cases, a worker may not be sure whether their child support case is in the

CSP system, the date the case was closed or whether arrears are still owed. When a

worker is unsure, the worker should report the case as a conflict of interest. Under

no circumstances, may a worker access their own case file using CSP computer

screens or other records available to them as DHS employees in order to determine

this information.

It is a violation of policy for a DHS employee to access their own case file using CSP

computer screens or other records available to them as DHS employees.

FAQ on accessing own CSP case:

QUESTION: May a DHS employee use the Division of Child Support website

from home or from a non-DHS computer (example: personal computer at home) to

access information about their own CSP case?

ANSWER: Yes.



QUESTION: May DHS employees use CSP or other DHS screens available to

them as DHS employees to access information about their own CSP case?

ANSWER: No.

Procedures

Staff who have a potential conflict of interest should report the conflict using the Notice

of Conflict of Interest with a Child Support Program Case (DHS 429).

Procedures for reporting a conflict of interest may be found at DHS-060-030-01, Conflict

of Interest - Child Support Program procedure.